Comparative effectiveness of Pregabalin given by fixed dose method and flexible dose method on treating central post-stroke pain / 临床神经病学杂志

Objective To compare the effectiveness of Pregabalin given by fixed dose method and flexible dose method on treating central post-stroke pain.Methods Patients with central post-stroke pain were consecutively enrolled and randomized into fixed group and flexible group.The patients in fixed group were given pregabalin 300 mg per day for 8 weeks.The patients in flexible group were given pregabalin as follows:150 mg per day for 2 weeks, 300 mg per day for 2 weeks and 450 mg per day for 4 weeks.The primary outcome was numerical rating scale ( NRS) . The secondary outcomes included adverse effects, hospital anxiety and depression scales ( HADS ) and Athens insomnia scale ( AIS) .Results A total of 132 participants were enrolled with 65 in fixed group and 67 in flexible group from Jul 2009 to Dec 2014.Two patients in fixed group gave up the treatment while 7 patients gave up in flexible group though no significant difference was observed.Finally, 63 patients in fixed group and 60 patients in flexible group were included into analysis.There was no significant difference on gender, age, medical history between two groups. Compared with baseline, the NRS、HADS-A、HADS-D and AIS score were significantly decreased ( all P<0.05 ) .However, there was no significant difference of these scores between the two groups. Conclusion Two regimens of pregabalin showed the similar efficiency and safety to treat CPSP, however, fixed dose seemed to be more acceptable.

Thalamic Pain Misdiagnosed as Cervical Disc Herniation

Thalamic pain is a primary cause of central post-stroke pain (CPSP). Clinical symptoms vary depending on the location of the infarction and frequently accompany several pain symptoms. Therefore, correct diagnosis and proper examination are not easy. We report a case of CPSP due to a left acute thalamic infarction with central disc protrusion at C5-6. A 45-year-old-male patient experiencing a tingling sensation in his right arm was referred to our pain clinic under the diagnosis of cervical disc herniation. This patient also complained of right cramp-like abdominal pain. After further evaluations, he was diagnosed with an acute thalamic infarction. Therefore detailed history taking should be performed and examiners should always be aware of other symptoms that could suggest a more dangerous disease.

Zhongfeng-Tengtong decoction combined with pregabalin for central post-stroke pain / 国际中医中药杂志

Objective To observe the clinical effect of Zhongfeng-Tengtong decoction combined with tramadol in the treatment of central post-stroke pain (CPSP). Methods A total of 121 patients with stroke were recruited in our hospital. The patients were randomly divided into 2 groups by the ramdom number table method, 61 patients in the treatment group and 60 in the control group. All patients received conventional treatment of stroke secondary prevention, and the control group received oral tramadol hydrochloride sustained release tablets, while the treatment group received Zhongfeng-Tengtong decoction based on the intervention of control group. Both groups were treated for 14 days. The outcomes included Numerical Rating Scale (NRS), Fugl-Meyer Assessment (FMA), Stroke Specific Quality of Life Scale (SS-QOL), and the changes of hemorheology indexes of the 2 groups before and after treatment. Results After treatment, the NRS scores of treatment group were significantly lower than the control group (2.5 ± 0.4 vs. 4.6 ± 0.7;t=20.303, P<0.01). and FMA and SS-QOL scores of treatment group were significantly higher than the control group (FMA 57.1 ± 18.1 vs. 44.2 ± 12.5;t=4.702, P<0.01), (SS-QOL 193.4 ± 25.6 vs. 165.4 ± 22.8;t=6.536, P<0.01). The whole blood viscosity, plasma viscosity, fibrinogen and thrombosis coefficient of treatment group were significantely lower than the control group (whole blood viscosity 4.22 ± 0.13 mPa?s vs. 4.56 ± 0.41 mPa?s, t=14.452, P<0.01;plasma viscosity 1.72 ± 0.31 mPa?s vs. 2.33 ± 0.23 mPa?s, t=14.258, P<0.01; fibrinogen 3.72 ± 0.49 g/L vs. 4.98 ± 0.41 g/L, t=17.783, P<0.01; thrombosis coefficient 0.76 ± 0.30 vs. 1.11 ± 0.20, t=8.178, P<0.01). Conclusions Zhongfeng-Tengtong decoction combined with tramadol could alleviate the pain symptom in patients with CPSP, improve the movement function of limbs and improve the quality of life.