Arnold Lesley M, Crofford Leslie J, Martin Susan A, Young James P, Sharma Uma
Women's Health Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Pain Med. 2007 Nov-Dec;8(8):633-8. doi: 10.1111/j.1526-4637.2007.00332.x.
To assess symptoms of anxiety and depression in a large cohort of fibromyalgia patients and to determine the impact of these symptoms on response of pain to pregabalin treatment.
Patients completed the Hospital Anxiety and Depression Scale at the baseline visit in a randomized, controlled trial of pregabalin for treatment of fibromyalgia. Mean anxiety and depression subscale scores were calculated, and proportions of patients by symptom severity were determined. The difference between the proportion of patients reporting anxiety and depression at baseline was tested using McNemar's test. Baseline anxiety and depression were evaluated as covariates by including them-as interaction terms with treatment-in an ancova model. A path analysis evaluated the association between improvements in anxiety and depression and pain relief.
In total, 529 patients were enrolled. Significantly more patients reported anxiety symptoms (71%) than depressive symptoms (56%) (P < 0.0001). Improvement in pain symptoms with pregabalin compared with placebo did not depend linearly on baseline anxiety or depression scores. By path analysis, 75% of the pain reduction was not explained by improvements in anxiety and depressive symptoms.
Anxiety symptoms were more common than depressive symptoms in this cohort. Our results suggest patients with fibromyalgia should be routinely assessed for the presence of both anxiety and depression. The pain treatment effect of pregabalin did not depend on baseline anxiety or depressive symptoms, suggesting pregabalin improves pain in patients with or without these symptoms. Much of the pain reduction appears to be independent of improvements in anxiety or mood symptoms.
评估一大群纤维肌痛患者的焦虑和抑郁症状，并确定这些症状对普瑞巴林治疗疼痛反应的影响。
在一项普瑞巴林治疗纤维肌痛的随机对照试验中，患者在基线访视时完成医院焦虑抑郁量表。计算焦虑和抑郁子量表的平均得分，并确定按症状严重程度划分的患者比例。使用McNemar检验来检验在基线时报告焦虑和抑郁的患者比例之间的差异。通过将基线焦虑和抑郁作为与治疗的交互项纳入协方差分析模型，将其作为协变量进行评估。路径分析评估焦虑和抑郁改善与疼痛缓解之间的关联。
总共招募了529名患者。报告焦虑症状的患者（71%）明显多于抑郁症状的患者（56%）（P < 0.0001）。与安慰剂相比，普瑞巴林使疼痛症状的改善并不线性地依赖于基线焦虑或抑郁评分。通过路径分析，75%的疼痛减轻无法用焦虑和抑郁症状的改善来解释。
在该队列中，焦虑症状比抑郁症状更常见。我们的结果表明，纤维肌痛患者应常规评估是否同时存在焦虑和抑郁。普瑞巴林的疼痛治疗效果不依赖于基线焦虑或抑郁症状，这表明普瑞巴林可改善有或无这些症状患者的疼痛。大部分疼痛减轻似乎独立于焦虑或情绪症状的改善。
