Reed Barbara D, Caron Amy M, Gorenflo Daniel W, Haefner Hope K
Department of Family Medicine, University of Michigan, Ann Arbor, MI 48109-0708, USA.
J Low Genit Tract Dis. 2006 Oct;10(4):245-51. doi: 10.1097/01.lgt.0000225899.75207.0a.
To determine the efficacy of tricyclic antidepressants (TCAs) as treatment for vulvodynia, and to identify demographic factors and pain characteristics associated with improvement.
Between January 2001 and April 2004, women diagnosed with vulvodynia were offered TCA therapy. The patients rated their worst recent pain on a 10-point scale at baseline and at follow-up; improvement was classified as at least 50% reduction in reported pain from baseline.
Of 271 women diagnosed with vulvodynia, 209 (77.1%) were treated initially with a TCA (amitriptyline [n = 183], desipramine [n = 23], and other tricyclic medications [n = 3]). One hundred sixty-two (59.8%) of the women were followed up at a median period of 3.2 months after their initial visit, including 122 women who had started on a TCA. Of 83 women taking a TCA at the first follow-up, 49 (59.3%) improved by more than 50%, compared with 30 of 79 women not taking TCA at follow-up (improvement rate = 38.0%; p =.007; odds ratio = 2.35; 95% CI = 1.23-4.42). Multivariate analysis indicated that age, severity of pain, diagnosis (localized vs generalized vulvar pain), length of time with pain before treatment, age at menarche, use of oral contraceptives, and the number of previous pregnancies were not associated with the outcome; however, taking a TCA at the time of the first follow-up was strongly associated with improvement (p <.001; odds ratio = 4.23; 95% CI = 1.98-9.01). Repeated analysis including only those women prescribed with amitriptyline rather than any tricyclic revealed similar results.
Women with vulvodynia who were prescribed a TCA in general (or amitriptyline, specifically) were more likely to have pain improvement compared with those women not taking these medications at follow-up. Randomized, controlled studies of TCAs versus other treatments are needed to clarify the overall effectiveness of these drugs.
确定三环类抗抑郁药（TCAs）治疗外阴痛的疗效，并确定与病情改善相关的人口统计学因素和疼痛特征。
2001年1月至2004年4月期间，为诊断为外阴痛的女性提供TCA治疗。患者在基线和随访时以10分制对其最近最严重的疼痛进行评分；改善定义为报告的疼痛较基线至少减轻50%。
在271例诊断为外阴痛的女性中，209例（77.1%）最初接受TCA治疗（阿米替林[n = 183]、地昔帕明[n = 23]和其他三环类药物[n = 3]）。其中162例（59.8%）女性在初次就诊后的中位时间3.2个月时接受了随访，包括122例开始服用TCA的女性。在首次随访时服用TCA的83例女性中，49例（59.3%）疼痛改善超过50%，而在随访时未服用TCA的79例女性中有30例改善（改善率 = 38.0%；p = 0.007；优势比 = 2.35；95%可信区间 = 1.23 - 4.42）。多变量分析表明，年龄、疼痛严重程度、诊断（局限性与广泛性外阴疼痛）、治疗前疼痛持续时间、初潮年龄、口服避孕药的使用以及既往妊娠次数与结局无关；然而，首次随访时服用TCA与病情改善密切相关（p < 0.001；优势比 = 4.23；95%可信区间 = 1.98 - 9.01）。仅对那些开具阿米替林而非任何三环类药物的女性进行重复分析，结果相似。
与随访时未服用这些药物的女性相比，总体上（或具体而言，阿米替林）开具TCA的外阴痛女性更有可能疼痛改善。需要对TCA与其他治疗方法进行随机对照研究，以阐明这些药物的总体有效性。
