Department of Anesthesiology, The University of Michigan, Ann, Arbor, MI, USA.
Ther Clin Risk Manag. 2008 Dec;4(6):1331-42. doi: 10.2147/tcrm.s3396.
Fibromyalgia syndrome is a common chronic pain disorder of unknown etiology. The lack of understanding of the pathophysiology of fibromyalgia has made this condition frustrating for patients and clinicians alike. The most common symptoms of this disorder are chronic widespread pain, fatigue, sleep disturbances, difficulty with memory, and morning stiffness. Emerging evidence points towards augmented pain processing within the central nervous system (CNS) as having a primary role in the pathophysiology of this disorder. Currently the two drugs that are approved by the United States Food and Drug Administration (FDA) for the management of fibromyalgia are pregabalin and duloxetine. Newer data suggests that milnacipran, a dual norepinephrine and serotonin reuptake inhibitor, may be promising for the treatment of fibromyalgia. A double-blind, placebo-controlled trial of milnacipran in 125 fibromyalgia patients showed significant improvements relative to placebo. Milnacipran given either once or twice daily at doses up to 200 mg/day was generally well tolerated and yielded significant improvements relative to placebo on measures of pain, patient's global impression of change in their disease state, physical function, and fatigue. Future studies are needed to validate the efficacy of milnacipran in fibromyalgia.
纤维肌痛综合征是一种常见的慢性疼痛障碍，病因不明。由于对纤维肌痛的病理生理学缺乏了解，这种疾病让患者和临床医生都感到沮丧。这种疾病最常见的症状是慢性广泛性疼痛、疲劳、睡眠障碍、记忆力困难和晨僵。新出现的证据表明，中枢神经系统（CNS）内增强的疼痛处理在这种疾病的病理生理学中起主要作用。目前，美国食品和药物管理局（FDA）批准的两种用于治疗纤维肌痛的药物是普瑞巴林和度洛西汀。新的数据表明，米那普仑，一种双重去甲肾上腺素和 5-羟色胺再摄取抑制剂，可能是治疗纤维肌痛的有希望的药物。一项对 125 例纤维肌痛患者进行的米那普仑双盲、安慰剂对照试验显示，与安慰剂相比，米那普仑有显著改善。米那普仑每天一次或两次服用，剂量高达 200mg/天，通常耐受性良好，与安慰剂相比，在疼痛、患者对疾病状态变化的总体印象、身体功能和疲劳方面有显著改善。需要进一步的研究来验证米那普仑在纤维肌痛中的疗效。
