Transforaminal Epidural Steroid Injection for Zoster－Related Pain： The Golden Period for the Best Outcome

Pain Physician 2021； 24：E669－E676 • ISSN 2150－1149

经椎间孔硬膜外注射类固醇治疗

带状疱疹相关疼痛：最佳结果的黄金时期

Background

Zoster－related pain （ZRP） has many negative effects on a patient’ s quality of life． The transforaminal steroid injection （TFESI）， which reduces neural inflammation and pain， has been advocated by pain physicians． Many reports demonstrated that early administration of TFESI showed better efficacy； however， the golden period during which TFESI is most effective remains unclear

背景：带状疱疹相关疼痛（ZRP）对患者的生活质量有许多负面影响。经椎间孔注射类固醇（TFESI），可以减少神经炎症和疼痛，已被疼痛内科医生提倡。许多报道表明，早期使用TFESI显示出较好的疗效，然而，TFESI最有效的黄金时期仍不清楚。

Objectives

This multicentre retrospective cohort study aimed to identify the golden period by which TFESI yields the best outcome in patients with ZRP ．

目的：这项多中心回顾性队列研究旨在确定TFESI在ZRP患者中产生最佳结局的黄金时期。

Methods

After performing the TFESI in patients with ZRP ， the patients were classified into two groups： the effective group （E） and the not effective group （N） based on the changes in the pain intensity 3 months after the TFESI． The receiver operating characteristic （ROC） curve analysis was used to assess the cut－off time point for predicting TFESI effectiveness． Furthermore， a logistic regression analysis was performed to identify patients’ factors associated with a successful treatment outcome

方法：对ZRP患者实施TFESI后，根据TFESI后3个月疼痛强度的变化，将患者分为有效组（E组）和无效组（N组）。受试者工作特征（ROC）曲线分析用于评估预测TFESI疗效的截止时间点。此外，还进行了Logistic回归分析，以确定与成功治疗结果相关的患者因素。

Result

Of the 302 patients， 186 and 116 patients were classified into the E and N group， respectively． ROC curve analysis showed that the best cut－off time point for TFESI was 12 weeks （95％ confidence interval ［CI］； 10－14 weeks） after the onset of HZ． The only variable associated with a favorable outcome was a symptom duration of ≤ 12 weeks compared with ＞ 12 weeks （Odd ratio， 0．107； 95％ CI， 0．055－0．205； P ＜ 0．001）． Other patient variables were not significantly associated with the effectiveness of TFESI． TFESI was most effective when administered within 12 weeks of the onset of herpes zoster．

结果：302例患者中，分为E组186例，N组116例。ROC曲线分析显示，TFESI的最佳截断点为发病后12周（95％可信区间；10～14周）。唯一与有利结果相关的变量是≤症状持续时间为12周，而不是＞12周（奇数比，0．107；95％CI，0．055－0．205；P＜0．001）。其他患者变量与TFESI的有效性没有显著相关性。TFESI在带状疱疹发病后12周内给药最有效。

Limitation

This study was not a prospective randomized controlled trial （RCT） and the follow－up period was only 3 months after TFESI．

限制：本研究不是前瞻性随机对照试验（RCT），随访时间仅为TFESI后3个月。

Conclusion

TFESI is more effective when administered within 12 weeks of onset of herpes zoster．

结论：TFESI在带状疱疹发病后12周内应用效果更好。

RefeRences：

1． Johnson RW， Rice AS． Clinical practice． Postherpetic neuralgia． N Engl J Med 2014； 371：1526－1533．

2． Opstelten W， Van Wijck AJ， Van Essen GA， et al． The PINE study： rationale and design of a randomised comparison of epidural injection of local anaesthetics and steroids versus care－as－usual to prevent postherpetic neuralgia in the elderly ［ISRCTN32866390］． BMC Anesthesiol 2004； 4：2．

3． Kang DH， Kim SY， Kim HG， Park JH， Kim TK， Kim KH． Earlier treatment improves the chances of complete relief from postherpetic neuralgia． Korean J Pain 2017； 30：214－219

4． Kim ED， Bak HH， Jo DH， Park HJ． Clinical efficacy of transforaminal epidural injection for management of zo

5． Ster－associated pain： a retrospective analysis． Skeletal Radiol 2018； 47：253－260．Doo AR， Choi JW， Lee JH， et al． The efficacy of selective nerve root block for the long－term outcome of postherpetic neuralgia． Korean J Pain 2019； 32：215－222．

文献整理翻译：差劲先森。

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