UC San Diego Medical Center, Anesthesiology, San Diego, CA 92037, USA.
Expert Opin Drug Saf. 2013 May;12(3):367-74. doi: 10.1517/14740338.2013.775242. Epub 2013 Feb 27.
The immunomodulatory and anti-inflammatory drug thalidomide was first introduced in 1957 as a sleep aid and treatment for morning sickness. It was subsequently removed from the market due to severe teratogenic side effects and then returned to the market as a treatment for myelodysplastic syndrome and multiple myeloma. Lenalidomide is an analog of thalidomide with similar efficacy but improved side-effect profile. There are reports and studies of both agents for the treatment of chronic pain, especially complex regional pain syndrome (CRPS). Effective medical and interventional therapies for CRPS are limited. The use of novel immunomodulatory and anti-inflammatory drugs such as thalidomide and lenalidomide may offer a new approach to the treatment of CRPS.
The mechanism of action, adverse effect profile, and regulatory history of thalidomide and lenalidomide will be reviewed. The literature search for pain treatment includes case series and preliminary trials for CRPS, and case reports and case series for other chronic pain conditions.
Lenalidomide has a more favorable adverse effect profile compared to its parent compound thalidomide. Both agents, however, have significant potential adverse effects. Evidence of efficacy for chronic pain syndromes such as CRPS remains limited. Further studies are needed before these agents can be recommended for use in CRPS or other chronic pain syndromes.
免疫调节和抗炎药物沙利度胺于 1957 年首次作为助眠剂和晨吐治疗药物推出。由于严重的致畸副作用，它随后被从市场上撤出，然后又作为骨髓增生异常综合征和多发性骨髓瘤的治疗药物重新回到市场。来那度胺是沙利度胺的类似物，具有相似的疗效，但副作用谱有所改善。这两种药物都有用于治疗慢性疼痛的报告和研究，尤其是复杂区域疼痛综合征（CRPS）。CRPS 的有效医学和介入治疗方法有限。使用新型免疫调节和抗炎药物，如沙利度胺和来那度胺，可能为 CRPS 的治疗提供新方法。
将回顾沙利度胺和来那度胺的作用机制、不良影响概况和监管历史。用于疼痛治疗的文献检索包括 CRPS 的病例系列和初步试验，以及其他慢性疼痛疾病的病例报告和病例系列。
来那度胺与母体化合物沙利度胺相比，具有更有利的不良影响概况。然而，这两种药物都有很大的潜在不良影响。CRPS 等慢性疼痛综合征的疗效证据仍然有限。在这些药物可推荐用于 CRPS 或其他慢性疼痛综合征之前，还需要进一步的研究。
