Department of Psychiatry and Psychotherapy, Philosophenweg 3, University Hospital, Jena, Germany.
J Clin Psychopharmacol. 2011 Feb;31(1):103-7. doi: 10.1097/JCP.0b013e3182046797.
Previous studies reported increased heat pain thresholds and decreased ischemic pain thresholds in patients experiencing depression. The increased sensitivity to ischemic muscle pain was assumed to represent a model for the investigation of physical symptoms in the disease. Here, we explored how the serotonin and noradrenaline reuptake inhibitor duloxetine influences experimental pain thresholds and tolerances in depressed patients during treatment. Twenty-two patients experiencing unipolar depression were included. Pain assessments were conducted unmedicated at baseline, after 1 week, and after 6 weeks of duloxetine treatment. We observed the expected clinical response of patients indicated by a significant reduction in the Montgomery Depression Rating Scale after 6 weeks. At baseline, we found increased heat pain thresholds in patients in comparison to controls while patients simultaneously rated augmented pain perception on the visual analog scale. In contrast, patients were significantly more perceptive to ischemic muscle pain at baseline. During treatment, the examined pain thresholds showed differential changes: Increased heat pain thresholds of patients normalized during treatment, whereas no significant change was observed for ischemic pain thresholds. Thus, our results might change the view on the paradox of pain perception in major depression because increased heat pain thresholds are associated with augmented pain perception in the disease.
先前的研究报告称，抑郁症患者的热痛阈值升高，缺血性疼痛阈值降低。人们认为对缺血性肌肉疼痛的敏感性增加代表了对疾病中身体症状进行研究的一种模式。在这里，我们探讨了在治疗过程中，5-羟色胺和去甲肾上腺素再摄取抑制剂度洛西汀如何影响抑郁患者的实验性疼痛阈值和耐受度。共纳入 22 名患有单相抑郁症的患者。在未用药的情况下，分别在基线、治疗 1 周和治疗 6 周时进行疼痛评估。我们观察到患者的预期临床反应，即经过 6 周后蒙哥马利抑郁评定量表显著降低。在基线时，与对照组相比，患者的热痛阈值升高，而患者同时在视觉模拟量表上报告疼痛感知增强。相比之下，患者在基线时对缺血性肌肉疼痛的感知更为明显。在治疗过程中，检查的疼痛阈值显示出不同的变化：患者的热痛阈值升高在治疗过程中恢复正常，而缺血性疼痛阈值没有明显变化。因此，我们的结果可能会改变对重性抑郁症中疼痛感知悖论的看法，因为热痛阈值升高与疾病中疼痛感知增强有关。
