Master Chen in his 40s is a bus driver. He usually works 8-10 hours a day, rain or shine. He does not smoke or drink, and he is always in good health.
1 month ago, Master Chen suddenly felt a slight tingling and itching on his left flank, and he could see a few small papules . At first he thought it was an allergy, so he applied a little anti-allergic medicine I drove to continue working, But within 2 days, a large area of small blisters began to appear on his back, left flank and upper abdomen, and the pain was obviously aggravated, seriously affecting sleep , Master Chen was a little scared, so Come to the hospital. After examination, doctor finally diagnosed herpes zoster , and admitted Master Chen to the hospital, and gave antiviral, nutritional nerve, pain relief and other symptomatic treatment. After a period of treatment, Master Chen’s herpes has completely healed , but it is still left behind There is a discharge-like pain in the left side of the flank , but because of work needs, there is no way to continue hospitalization. Dr.
prescribed pregabalin , methylcobalamin and vitamin B1 for him when he was discharged from the hospital, and told him to take it according to the doctor's instructions, and to return to the clinic in about a month. Master Chen was very puzzled when he saw the anti-epileptic drug on the package of pregabalin. He asked the doctor that he was not epileptic, how could he take this drug? Dr. explained that dopregabalin itself has multiple mechanisms of action. It can not only treat epilepsy, but also inhibit nerve pain and protect nerve function. It has a good therapeutic effect on herpetic pain, but this drug does not It is suitable for long-term use, so after taking it for a period of time, you must gradually reduce the dose . The doctor told Master Chen to pay attention to rest and to take medicine regularly according to the doctor's advice. After a period of treatment, Master Chen's nerve pain improved a lot.
1. Mechanism and characteristics of pregabalin
Pregabalin is a new type of gamma-aminobutyric acid receptor blocker , also known as Lyrica and Lyrica clinically, is a commonly used clinical anti-inflammatory drug Epilepsy drugs and painkillers, It is worth mentioning that pregabalin is mainly used to treat neuropathic pain, which is very different from non-steroidal anti-inflammatory drugs , so it is often used clinically to treat epilepsy, band Herpetic pain, diabetic peripheral neuropathy, fibromyalgia syndrome and other chronic diseases, the clinical effect is remarkable.
Pregabalin has a very special mechanism of action. It is different from non-steroidal anti-inflammatory drugs, narcotics and other painkillers. Pregabalin itself does not have anti-inflammatory and analgesic effectsIt has no obvious inhibitory effect on physiological pain , Its main function is with the presynaptic membrane of middle neurons in the central nervous system of . It can reduce the release of excitatory neurotransmitters by inhibiting the calcium channel in of the central nervous system of , thus producing obvious analgesia and anticonvulsant Act .
Pharmacological studies have shown that pregabalin can bind to voltage-gated calcium channels in central nervous system tissues, and inhibit the influx of calcium ions, thereby reducing glutamate, norepinephrine and substance P, etc. Release of a central excitatory neurotransmitter, reduce central nervous excitability and abnormal discharge, regulate brain function , effectively treat epilepsy.
Secondly, pregabalin can reduce the release of various excitatory presynaptic transmitters, and then reduce the central sensitization reaction caused by nerve damage, improve the pain threshold, and reduce the pain caused by central or peripheral nerve damage Induced pain .
Finally, a number of studies have shown that pregabalin can regulateThe potassium ion channel on the dorsal root ganglion, which in turn inhibits the outflow of potassium ions , inhibits and reduces the excitability of dorsal root ganglion cells, and inhibits the transmission of signals between synapses , which is important for the treatment zone Herpes zoster pain has an obvious effect, because the herpes zoster virus usually starts from the dorsal root ganglion, Therefore, the application of pregabalin from the acute stage of herpes zoster can not only effectively relieve pain, but also protect the structure of the dorsal root ganglion Integrity, reducing the incidence of herpes zoster sequelae.
2. Pregabalin is often used clinically to treat these 5 diseases
Pregabalin has a wide range of clinical applications, almost all neuropathic pain can be treated with it, and it can be used in the treatment of certain diseases (such as lumbar disc herniation , cervical spondylotic radiculopathy , etc.) can be used in combination with non-steroidal anti-inflammatory drugs, opioid painkillers, etc., and will not produce obvious side effects, but the dosage and method of pregabalin are different in the treatment of different diseases , It is recommended that you standardize the medication under the guidance of a doctor. Clinically, pregabalin is often used to treat the following 5 diseases.
1, epilepsy
epilepsy is one of the common clinical central system diseases, its essence is due to the abnormal activity of the central nervous system, resulting in abnormal discharge, clinical manifestations can be sudden loss of consciousness, trismus, limb rigidity, And with paroxysmal spasm , but can return to normal after a short time . Pregabalin is one of the commonly used drugs in the clinical treatment of epilepsy, but due to its limited effect, it is only used as an adjuvant drug for the treatment of partial epileptic seizures in adults, commonly used sodium valproate, phenytoin sodium, and other drugs in combination , clinical research results show that pregabalin can effectively inhibit the abnormal discharge of the central nervous system and reduce the number of seizures in patients with epilepsy, which is of great significance for improving the prognosis of the disease .
2, herpetic neuralgia
herpetic neuralgia is the neuropathic pain induced by the herpes zoster virus invading the dorsal root ganglion, resulting in damage to nerve cells and nerve fibers, which can be divided into acute attacks from the course of the disease There are two types of pain and postherpetic neuralgia, among which postherpetic neuralgia is the most stubborn, and pregabalin is the first-line drug for clinical treatment of herpetic neuralgia. Clinical studies have shown that pregabalin has a good analgesic effect whether it is for acute pain or postherpetic neuralgia, especially when pregabalin is applied in the acute phase of herpes zoster, it can effectively protect the nerve structure and reduce nerve damage , reduce the chance of postherpetic neuralgia .
3 Diabetic peripheral neuropathy
Diabetic peripheral neuropathy is one of the common complications of diabetic patients. Its essence is that the blood is in a state of high sugar for a long time, which leads to abnormal energy metabolism of nerve cells, which in turn causes apoptosis of nerve tissue And damage, resulting in pain, numbness and paresthesia, the most common extremities, and pregabalin is the treatment of diabetic peripheral neuropathy, commonly used drugs to reduce pain in patients. Clinical studies have shown that oral administration of pregabalin can effectively relieve limb numbness, pain and other discomforts in patients with diabetic peripheral neuropathy, improve their quality of life, and improve the prognosis of the disease.
4, fibromyalgia syndrome
fibromyalgia syndrome is a relatively rare clinical chronic pain disease, the pathogenesis is not yet clear, the main clinical features are long-term muscle pain, stiffness, paresthesia, etc., at the same time It is often accompanied by sleep disturbance and fatigue, and pregabalin is one of the commonly used drugs for the treatment of fibromyalgia syndrome. clinical researchStudies have shown that pregabalin can increase the pain threshold of patients with fibromyalgia syndrome, thereby improving the patient's sensitivity to pain, improving their living and working conditions, and improving sleep quality .
5, Analgesia after orthopedic surgery
At present, multimodal analgesia is one of the best strategies for perioperative pain management in orthopedics. Analgesic effect after surgery. As a central analgesic, pregabalin can effectively inhibit the sensitization effect of the central and peripheral nerves and increase the patient's pain threshold. It is often used in combination with non-steroidal anti-inflammatory drugs and opioid analgesics to reduce the pain of patients after surgery , to speed up postoperative recovery of patients .
3. Can pregabalin be taken for a long time? Are there any side effects?
Since pregabalin can treat many pain diseases, can we take pregabalin for a long time? The answer is that except for epileptic patients, long-term oral administration of pregabalin is not recommended clinically, because long-term oral administration of pregabalin will not only inhibit the central nervous system, but also affect kidney function. In addition, long-term oral administration of pregabalin will lead to drug resistance and dependence in the human body, requiring continuous additional doses, which will induce a variety of adverse reactions. Therefore, long-term oral administration of pregabalin is not recommended for most pain diseases.
Pharmacokinetic studies show that after oral administration of pregabalin, the onset of effect is very fast, about can exert obvious drug effect in about 1 hour, but the half-life of pregabalin is only 6-8 hours, so it often needs daily Oral 2-3 times to reach a stable drug concentration .
Secondly, the kidney is the main organ for metabolizing and excreting pregabalin, and about 90% of the drug is excreted through the urine in the form of prototype, so long-term oral administration is likely to affect even the function, especially the creatinine clearance rate for pregabalin Excretion of Bahrain has a direct effect, so should be used with caution in patients with renal insufficiency.
Third, because pregabalin can enter the central nervous system through the blood-brain barrier, If it is taken orally in large doses for a long time, it will easily lead to the cumulative effect of the drug in the central nervous system, resulting in excessive inhibition of the central nervous system, resulting in dizziness, mental Adverse reactions such as depression, drowsiness, and even coma in severe cases.
Finally, Long-term oral administration of pregabalin is likely to lead to dependence, which makes it difficult for patients to stop the drug, and Long-term oral administration of pregabalin is likely to cause human tolerance, resulting in a decline in drug efficacy, requiring continuous additional doses, therefore For patients with chronic pain, pregabalin can be used as a short-term or phased medication, and it is not suitable for long-term use .
4. Take pregabalin scientifically and pay attention to the following 5 points
Because of the unique mechanism of action of pregabalin, its clinical efficacy in treating neuralgia is significant, and it will not affect dopamine and 5-serotonin in the central nervous system Neurotransmitters such as or noradrenaline are affected, so the safety is better, but it will still affect the central nervous system, liver and kidney functions, etc. Therefore, scientific administration is the key. Scientific administration of pregabalin should pay attention to the following 5 points.
First, pay attention to the dosage and administration method of pregabalin
Clinically, the dosage of pregabalin has two specifications of 75mg and 150mg per capsule , among which the specification of 150mg per capsule is often used to treat epilepsy, and the specification of 75mg per capsule is commonly used For the treatment of nerve pain, it should be noted that the daily dose of pregabalin should not exceed 300mg, otherwise it will easily lead to increased burden on the kidneys and induce renal function damage.
Second, pay attention to the adverse reactions of pregabalin
Using
the most common adverse reaction of pregabalin is the central nervous system inhibitory reaction
, such as dizziness, drowsiness, ataxia, confusion, fatigue, etc. Most patients can tolerate it, and if they cannot tolerate it, the drug dose needs to be adjusted, or other drugs should be used; secondly, Pregabalin has certain irritating effects on the gastrointestinal tract, which can easily cause abdominal pain, dry mouth, indigestion, etc. A adverse reaction of the digestive system ; third, high taking pregabalin for a long time is likely to cause kidney function damage, and creatinine rises , if it occurs, it is recommended to reduce the drug dose, or temporarily stop the drug; finally, extremely A small number of patients will experience face and lip edema after taking pregabalin, which is a serious allergic manifestation, and it is recommended that these patients who are allergic to pregabalin should not use this drug.
Third, pay attention to the use of pregabalin
Because pregabalin has a significant inhibitory effect on the central nervous system, Therefore, in the process of clinical application, we must try our best to use the minimum dose, and gradually increase the drug dose until the symptoms are improved Control ; Secondly, because pregabalin will cause drug dependence, sudden withdrawal of the drug will induce a rebound of the disease, resulting in aggravated pain, so must not stop the drug suddenly, you should gradually reduce the dose taken each time or reduce the number of daily doses , Epilepsy patients try to use the smallest dose for maintenance, the entire withdrawal process is best within 1-2 weeks .
Fourth, pay attention to the use of pregabalin for special groups of people
pregnant women are contraindicated , pregabalin has toxic effects on fetal development and may easily cause fetal malformation; Nervous system , reproductive system and other developmental abnormalities; children should be used with caution , there is currently a lack of research data on children, and the safety is unknown; the elderly try to reduce the dosage to avoid adverse reactions ; renal creatinine clearance rate <60ml/> with caution, as it is likely to cause further deterioration of renal function; patients who are allergic to pregabalin should use it with caution.
Fifth, pay attention to the combination of pregabalin
You should refrain from alcohol when taking pregabalin , otherwise it is easy to aggravate the inhibitory effect of pregabalin on the central nervous system, leading to drowsiness, coma and other adverse reactions; Pregabalin should not be combined with vascular tension combined use of antihypertensive drugs such as enzyme inhibitors may easily cause adverse reactions such as limb edema and urticaria; The dose of the drug can be reduced;When pregabalin is used in combination with sleeping pills, attention should be paid to whether the patient has adverse reactions such as dizziness and drowsiness, and the dosage should be adjusted in time if any adverse reactions occur.
V. Summary
In summary, pregabalin is a commonly used antiepileptic drug and analgesic drug in clinical practice, especially for chronic neuropathic pain. It can also be used in combination with non-steroidal anti-inflammatory drugs, opioid painkillers, etc.; secondly, pregabalin is not suitable for long-term use, which may easily lead to drug tolerance and dependence, but attention should be paid to gradually reducing the dose of the drug, and it is not advisable to stop the drug suddenly; finally, when taking pregabalin, you should pay attention to possible adverse reactions, such as dizziness, dizziness, drowsiness, etc. If it occurs, you should respond to the doctor in time. The doctor can Adverse reactions can be mitigated by adjusting the dose or regimen of the drug.
