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Transcutaneous electrical nerve stimulation in combination with cobalamin injection for postherpetic neuralgia: a single-center randomized controlled trial.

American journal of physical medicine & rehabilitation (2013-11-08)
Gang Xu, Gang Xú, Yan Feng, Wei Zhen Tang, Zhong Wei Lv
ABSTRACT

The aim of this study was to explore the efficacy of transcutaneous electrical nerve stimulation (TENS) with locally injected cobalamin in relieving pain and improving activities of daily living in patients with postherpetic neuralgia. Ninety patients (≥50 yrs old) with postherpetic neuralgia with a pain score of 4 or greater were randomized to receive TENS and local injections of cobalamin or lidocaine or a combination of cobalamin and lidocaine for 8 wks. Treatment efficacy was assessed on the basis of worst pain severity, global impression of change, activities of daily living, and quality-of-life. Time × group interaction, group differences, and time effect on worst pain at each follow-up point were statistically significant (P < 0.05) among the groups. In the group receiving TENS and local injection of cobalamin and in the group receiving TENS with a combination of cobalamin and lidocaine, the mean ± SD pain scores were 4.0 ± 1.4 and 4.1 ± 1.2 at endpoint, 28 and 26 patients achieved pain reduction of 30% or greater, and 14 and 10 perceived worst pain of 3 or less, respectively. The activities of daily living and quality-of-life data at the study endpoint showed significant benefits in the group receiving TENS and local injection of cobalamin and in the group receiving TENS and a combination of cobalamin and lidocaine (P < 0.05). In the group receiving TENS and local injection of lidocaine, the mean ± SD pain score was 6.1 ± 1.2 at the endpoint relative to baseline (P < 0.05), and only six patients achieved pain reduction of 30% or greater. TENS in combination with local cobalamin injection has a significant analgesic effect.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Lidocaine hydrochloride monohydrate, solid
Sigma-Aldrich
Lidocaine, powder
Sigma-Aldrich
Lidocaine, analytical standard
Sigma-Aldrich
Vitamin B12, BioReagent, suitable for cell culture, suitable for insect cell culture, suitable for plant cell culture, ≥98%
Supelco
Lidocaine, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
Vitamin B12, ≥98%
USP
Lidocaine, United States Pharmacopeia (USP) Reference Standard
Supelco
Lidocaine hydrochloride, Pharmaceutical Secondary Standard; Certified Reference Material
Lidocaine, European Pharmacopoeia (EP) Reference Standard
Lidocaine hydrochloride, European Pharmacopoeia (EP) Reference Standard
Sigma-Aldrich
Cyanocobalamin, meets USP testing specifications
Sigma-Aldrich
Cyanocobalamin, tested according to Ph. Eur.
Supelco
Cyanocobalamin (B12), analytical standard
Supelco
Cyanocobalamin, pharmaceutical secondary standard, certified reference material
Cyanocobalamin, European Pharmacopoeia (EP) Reference Standard
Supelco
Cyanocobalamin (Vitamin B12) solution, 1.0 mg/mL in methanol, ampule of 1 mL, certified reference material, Cerilliant®