O'Malley P G, Balden E, Tomkins G, Santoro J, Kroenke K, Jackson J L
Division of General Internal Medicine, Walter Reed Army Medical Center Washington, DC, USA.
J Gen Intern Med. 2000 Sep;15(9):659-66. doi: 10.1046/j.1525-1497.2000.06279.x.
Fibromyalgia is a common, poorly understood musculoskeletal pain syndrome with limited therapeutic options.
To systematically review the efficacy of antidepressants in the treatment of fibromyalgia and examine whether this effect was independent of depression.
Meta-analysis of English-language, randomized, placebo-controlled trials. Studies were obtained from searching MEDLINE, EMBASE, and PSYCLIT (1966-1999), the Cochrane Library, unpublished literature, and bibliographies. We performed independent duplicate review of each study for both inclusion and data extraction.
Sixteen randomized, placebo-controlled trials were identified, of which 13 were appropriate for data extraction. There were 3 classes of antidepressants evaluated: tricyclics (9 trials), selective serotonin reuptake inhibitors (3 trials), and S-adenosylmethionine (2 trials). Overall, the quality of the studies was good (mean score 5.6, scale 0-8). The odds ratio for improvement with therapy was 4.2 (95% confidence interval [95% CI], 2.6 to 6.8). The pooled risk difference for these studies was 0.25 (95% CI, 0.16 to 0.34), which calculates to 4 (95% CI, 2.9 to 6.3) individuals needing treatment for 1 patient to experience symptom improvement. When the effect on individual symptoms was combined, antidepressants improved sleep, fatigue, pain, and well-being, but not trigger points. In the 5 studies where there was adequate assessment for an effect independent of depression, only 1 study found a correlation between symptom improvement and depression scores. Outcomes were not affected by class of agent or quality score using meta-regression.
Antidepressants are efficacious in treating many of the symptoms of fibromyalgia. Patients were more than 4 times as likely to report overall improvement, and reported moderate reductions in individual symptoms, particularly pain. Whether this effect is independent of depression needs further study.
纤维肌痛是一种常见但了解不足的肌肉骨骼疼痛综合征，治疗选择有限。
系统评价抗抑郁药治疗纤维肌痛的疗效，并探讨这种疗效是否独立于抑郁。
对英文随机安慰剂对照试验进行荟萃分析。通过检索MEDLINE、EMBASE和PSYCLIT（1966 - 1999年）、Cochrane图书馆、未发表文献及参考文献获取研究。我们对每项研究进行独立重复评审以确定纳入及数据提取。
确定了16项随机安慰剂对照试验，其中13项适合数据提取。评估了3类抗抑郁药：三环类（9项试验）、选择性5-羟色胺再摄取抑制剂（3项试验）和S-腺苷甲硫氨酸（2项试验）。总体而言，研究质量良好（平均评分5.6，范围0 - 8）。治疗改善的比值比为4.2（95%可信区间[95%CI]，2.6至6.8）。这些研究的合并风险差为0.25（95%CI，0.16至0.34），即每治疗4（95%CI，2.9至6.3）例患者可使1例患者症状改善。当综合个体症状的疗效时，抗抑郁药可改善睡眠、疲劳、疼痛和幸福感，但对触发点无效。在5项对独立于抑郁的疗效进行充分评估的研究中，仅1项研究发现症状改善与抑郁评分之间存在相关性。使用荟萃回归分析，结局不受药物类别或质量评分的影响。
抗抑郁药对治疗纤维肌痛的多种症状有效。患者报告总体改善的可能性是原来的4倍多，并报告个体症状有中度减轻，尤其是疼痛。这种疗效是否独立于抑郁尚需进一步研究。
