Fishbain David A, Cutler R B, Lewis John, Cole Brandly, Rosomoff R Steele, Rosomoff H L
Department of Psychiatry, University of Miami School of Medicine, 1400 NW 10th Avenue, Miami Beach, FL 33136, USA.
Pain Med. 2004 Dec;5(4):359-65. doi: 10.1111/j.1526-4637.2004.04054.x.
This is a structured, evidence-based review of all available studies on the potential effectiveness of the atypical neuroleptics for the treatment of pain (analgesia). To determine what evidence, if any, exists for, or against, the effectiveness of the atypical neuroleptics for analgesia.
There has been significant controversy over whether the conventional neuroleptics (non-atypicals) have analgesic properties. A recent review (Patt et al. 1994) did conclude that the evidence for effectiveness was sparse, except for methotrimeprazine. However, that review did not include a new class of neuroleptics: the atypicals such as olazapine, risperidone, quetiapine, etc.
A computer and manual search for studies relating to the atypicals and their analgesic effectiveness produced 10 studies/reports. These were reviewed in detail, and information relating to the above problem was abstracted and placed into tabular form. Each report was also categorized by the type of study it represented according to the guidelines developed by the Agency for Health Care Policy and Research (AHCPR). The strength and consistency of the evidence represented by the 10 studies were then categorized according to the AHCPR guidelines. Conclusions of this review were based on these results.
Of the 10 studies/reports, four were characterized by AHCPR guidelines as Type II (experimental), two were Type III (quasiexperimental), two were Type IV (nonexperimental), and two were Type V (case reports). Of these studies/reports, 90% indicated that the atypicals did have an analgesic effect. The overall strength and consistency of this evidence using the AHCPR guidelines was, therefore, categorized as B (generally consistent from Type II, Type III, and Type IV studies).
Based on the above results, it was concluded that the reviewed data were generally consistent, suggesting that some of the atypicals may have an analgesic effect. There were, however, few double-blind, placebo-controlled studies, and many of the reports/studies had less than 50 patients. As such, this question requires further research.
这是一项基于证据的结构化综述，涵盖了所有关于非典型抗精神病药物治疗疼痛（镇痛）潜在有效性的现有研究。旨在确定是否存在支持或反对非典型抗精神病药物镇痛有效性的证据。
关于传统抗精神病药物（非非典型药物）是否具有镇痛特性一直存在重大争议。最近的一项综述（Patt等人，1994年）确实得出结论，除了甲哌氯丙嗪外，有效性证据稀少。然而，该综述未包括一类新的抗精神病药物：如奥氮平、利培酮、喹硫平等等非典型药物。
通过计算机和人工检索与非典型药物及其镇痛有效性相关的研究，共获得10项研究/报告。对这些进行了详细审查，并提取了与上述问题相关的信息并制成表格形式。每份报告还根据医疗保健政策和研究机构（AHCPR）制定的指南，按照其所代表的研究类型进行分类。然后根据AHCPR指南对这10项研究所示证据的强度和一致性进行分类。本综述的结论基于这些结果。
在这10项研究/报告中，根据AHCPR指南，4项为II型（实验性），2项为III型（准实验性），2项为IV型（非实验性），2项为V型（病例报告）。在这些研究/报告中，90%表明非典型药物确实具有镇痛作用。因此，根据AHCPR指南，该证据的总体强度和一致性被归类为B（II型、III型和IV型研究总体一致）。
基于上述结果，得出结论认为所审查的数据总体一致表明，某些非典型药物可能具有镇痛作用。然而，双盲、安慰剂对照研究很少，而且许多报告/研究的患者人数不足50人。因此，这个问题需要进一步研究。
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