Panerai A E, Monza G, Movilia P, Bianchi M, Francucci B M, Tiengo M
Department of Pharmacology, School of Medicine, University of Milan, Italy.
Acta Neurol Scand. 1990 Jul;82(1):34-8. doi: 10.1111/j.1600-0404.1990.tb01584.x.
Antidepressant drugs are increasingly used in the management of chronic pain. They are mainly prescribed for cancer-related pain and central pain, e.g. phantom or stump pain, post-herpetic neuropathy. However, no controlled clinical trials have validated their in either pathology. Thus, physicians still do not know whether antidepressants are really effective and which might be best. It is still debated whether the effect of antidepressants in the management of chronic pain is limited to the amelioration of frequently concomitant depression or extends to pain itself. To verify both the analgesic effect of tricyclic antidepressants, and the possible relationship between their antidepressant effect and the relief of central pain, we carried out a randomized, within-patient (cross-over) placebo-controlled study in patients suffering from central pain. The results clearly indicate the better analgesic effect of tricyclic antidepressants over placebo (p less than 0.0001). Within the antidepressants tested, chlorimipramine, a blocker of serotonin reuptake, is significantly more effective (p less than 0.0001) than notriptyline, a blocker of noradrenaline reuptake. Finally, the antinociceptive effect is independent of the effects of the two drugs on the symptoms of depression.
抗抑郁药物越来越多地用于慢性疼痛的治疗。它们主要用于治疗与癌症相关的疼痛和中枢性疼痛，如幻肢痛或残端痛、疱疹后神经痛。然而，尚无对照临床试验证实其在这两种病症中的疗效。因此，医生们仍然不知道抗抑郁药是否真的有效，哪种药物可能效果最佳。抗抑郁药在慢性疼痛治疗中的作用是仅限于改善常伴随的抑郁症状，还是也能扩展到疼痛本身，这一点仍存在争议。为了验证三环类抗抑郁药的镇痛效果，以及它们的抗抑郁作用与中枢性疼痛缓解之间可能存在的关系，我们对患有中枢性疼痛的患者进行了一项随机、患者自身对照（交叉）的安慰剂对照研究。结果清楚地表明，三环类抗抑郁药的镇痛效果优于安慰剂（p<0.0001）。在所测试的抗抑郁药中，5-羟色胺再摄取阻滞剂氯米帕明比去甲肾上腺素再摄取阻滞剂去甲替林显著更有效（p<0.0001）。最后，镇痛作用与这两种药物对抑郁症状的作用无关。
