Murina Filippo, Graziottin Alessandra, Felice Raffaele, Gambini Dania
Lower Genital Tract Disease Unit, V. Buzzi Hospital, University of Milan, Milan, Italy.
Center of Gynecology and Medical Sexology, H. San Raffaele Resnati, Milan, Italy.
J Obstet Gynaecol Can. 2017 Mar;39(3):131-137. doi: 10.1016/j.jogc.2016.12.035.
This study assessed the effectiveness of alpha lipoic acid (ALA) plus omega-3 polyunsaturated fatty acids (n-3 PUFAs) in combination with amitriptyline therapy in patients with vestibulodynia/painful bladder syndrome (VBD/PBS).
Women with VBD/PBS were randomly assigned to receive amitriptyline or amitriptyline plus a commercially available preparation (ALAnerv Age; Alfa Wassermann, Bologna, Italy) containing, in 2 capsules, ALA 600 mg plus docosahexaenoic acid 250 mg and eicosapentaenoic acid 16.67 mg. Symptoms of burning and pain were assessed using a 10-cm visual analog scale and the short form of the McGill-Melzack Pain Questionnaire.
Among 84 women who were randomized, the mean ± standard deviation dose of amitriptyline was 21.7 ± 6.6 mg/day, without statistical difference between the two groups. Pain, as assessed using both the pain rating index of the visual analog scale and the short-form McGill Pain Questionnaire, decreased significantly in both trial groups, with a greater effect seen with the addition of ALA and n-3 PUFAs. The addition of ALA/n-3 PUFAs to amitriptyline treatment was also associated with improvements in dyspareunia and pelvic floor muscle tone. The overall incidence of adverse events was low, and none led to treatment discontinuation.
The addition of ALA/n-3 PUFAs to amitriptyline treatment in patients with VBD/PBS appears to improve outcomes and may allow for a lower dosage of amitriptyline, which may lead to fewer adverse effects.
本研究评估了α-硫辛酸（ALA）加ω-3多不饱和脂肪酸（n-3 PUFAs）联合阿米替林治疗前庭性疼痛/膀胱疼痛综合征（VBD/PBS）患者的有效性。
将患有VBD/PBS的女性随机分配接受阿米替林治疗，或接受阿米替林加一种市售制剂（ALAnerv Age；意大利博洛尼亚的阿尔法·瓦瑟曼公司）治疗，该制剂每2粒胶囊含ALA 600毫克、二十二碳六烯酸250毫克和二十碳五烯酸16.67毫克。使用10厘米视觉模拟量表和麦吉尔-梅尔扎克疼痛问卷简表评估灼痛和疼痛症状。
在84名随机分组的女性中，阿米替林的平均±标准差剂量为21.7±6.6毫克/天，两组之间无统计学差异。使用视觉模拟量表的疼痛评分指数和麦吉尔疼痛问卷简表评估，两个试验组的疼痛均显著减轻，添加ALA和n-3 PUFAs的效果更明显。在阿米替林治疗中添加ALA/n-3 PUFAs还可改善性交困难和盆底肌张力。不良事件的总体发生率较低，且无一导致治疗中断。
在VBD/PBS患者的阿米替林治疗中添加ALA/n-3 PUFAs似乎可改善治疗效果，并可能允许降低阿米替林的剂量，从而减少不良反应。
