Department of Medicine, University of Arizona, Tucson, AZ, USA.
Statistics Laboratory, Bio5 Institute, Statistics GIDP, University of Arizona, Tucson, AZ, USA ; Faculty of ESTeM, University of Canberra, Canberra, ACT, Australia.
J Pain Res. 2013 Dec 9;6:755-63. doi: 10.2147/JPR.S52205. eCollection 2013.
Lumbar radiculopathy pain represents a major public health problem, with few effective long-term treatments. Preclinical neuropathic and postsurgical pain studies implicate the kinase adenosine monophosphate activated kinase (AMPK) as a potential pharmacological target for the treatment of chronic pain conditions. Metformin, which acts via AMPK, is a safe and clinically available drug used in the treatment of diabetes. Despite the strong preclinical rationale, the utility of metformin as a potential pain therapeutic has not yet been studied in humans. Our objective was to assess whether metformin is associated with decreased lumbar radiculopathy pain, in a retrospective chart review. We completed a retrospective chart review of patients who sought care from a university pain specialist for lumbar radiculopathy between 2008 and 2011. Patients on metformin at the time of visit to a university pain specialist were compared with patients who were not on metformin. We compared the pain outcomes in 46 patients on metformin and 94 patients not taking metformin therapy. The major finding was that metformin use was associated with a decrease in the mean of "pain now," by -1.85 (confidence interval: -3.6 to -0.08) on a 0-10 visual analog scale, using a matched propensity scoring analysis and confirmed using a Bayesian analysis, with a significant mean decrease of -1.36 (credible interval: -2.6 to -0.03). Additionally, patients on metformin showed a non-statistically significant trend toward decreased pain on a variety of other pain descriptors. Our proof-of-concept findings suggest that metformin use is associated with a decrease in lumbar radiculopathy pain, providing a rational for larger retrospective trials in different pain populations and for prospective trials, to test the effectiveness of metformin in reducing neuropathic pain.
腰椎神经根病疼痛是一个主要的公共健康问题，目前治疗方法效果有限，且无法长期缓解。临床前神经病理性和手术后疼痛研究表明，一磷酸腺苷激活的蛋白激酶（AMPK）作为一种潜在的治疗慢性疼痛的药理学靶点。二甲双胍通过 AMPK 起作用，是一种安全且临床可用的药物，用于治疗糖尿病。尽管有很强的临床前理论基础，但二甲双胍作为一种潜在的疼痛治疗药物在人类中的应用尚未得到研究。我们的目的是在回顾性图表审查中评估二甲双胍是否与腰椎神经根病疼痛减轻有关。我们对 2008 年至 2011 年间因腰椎神经根病到大学疼痛专家处就诊的患者进行了回顾性图表审查。与未服用二甲双胍的患者相比，在就诊时正在服用二甲双胍的患者被比较。我们比较了 46 名服用二甲双胍的患者和 94 名未接受二甲双胍治疗的患者的疼痛结果。主要发现是，使用二甲双胍与“现在疼痛”的平均值降低相关，在 0-10 视觉模拟量表上降低了 -1.85（置信区间：-3.6 至 -0.08），使用匹配倾向评分分析，并使用贝叶斯分析确认，平均降低了 -1.36（可信区间：-2.6 至 -0.03）。此外，服用二甲双胍的患者在各种其他疼痛描述上也表现出疼痛减轻的非统计学趋势。我们的概念验证结果表明，二甲双胍的使用与腰椎神经根病疼痛减轻有关，为在不同的疼痛人群中进行更大的回顾性试验以及前瞻性试验提供了合理依据，以测试二甲双胍在减轻神经病理性疼痛方面的有效性。
