Ikawa Masako, Yamada Kazuo
Department of Oral Surgery, Shizuoka Municipal Shimizu Hospital, Shizuoka, Japan.
Clin Neuropharmacol. 2010 May;33(3):163-4. doi: 10.1097/WNF.0b013e3181d61528.
The effectiveness of tricyclic antidepressants (TCAs) has been reported for treating pain disorder. However, the use of TCAs is contraindicated for patients with congenital long QT syndrome. We experienced a case of a 38-year-old woman with congenital long QT syndrome and pain disorder in the orofacial region, which was treated successfully with milnacipran. Although nortriptyline was effective for her pain, it could bring about fatal cardiac adverse events. Paroxetine was not effective in this case. Six weeks after the increase to 200 mg/d of milnacipran, her pain had completely disappeared, and her corrected QT interval time was 0.445 milliseconds. Milnacipran may be a safe and effective compound for patients with pain disorder in whom TCAs are contraindicated.
三环类抗抑郁药（TCA）治疗疼痛障碍的有效性已有报道。然而，先天性长QT综合征患者禁用TCA。我们遇到一例38岁先天性长QT综合征且患有口面部疼痛障碍的女性患者，使用米那普明成功治愈。尽管去甲替林对她的疼痛有效，但可能会引发致命的心脏不良事件。帕罗西汀在该病例中无效。将米那普明增至200mg/d六周后，她的疼痛完全消失，校正QT间期为0.445毫秒。对于TCA禁用的疼痛障碍患者，米那普明可能是一种安全有效的化合物。
