Martínez-Martínez Laura-Aline, Pérez Luis-Fernando, Becerril-Mendoza Lizbeth-Teresa, Rodríguez-Henriquez Pedro, Muñoz Omar-Eloy, Acosta Gumaro, Silveira Luis H, Vargas Angélica, Barrera-Villalpando María-Isabel, Martínez-Lavín Manuel
Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Hospital Juárez, Mexico City, Mexico.
Clin Rheumatol. 2017 Aug;36(8):1879-1884. doi: 10.1007/s10067-017-3664-z. Epub 2017 May 2.
A consistent line of investigation proposes that fibromyalgia is a sympathetically maintained neuropathic pain syndrome. Dorsal root ganglia sodium channels may play a major role in fibromyalgia pain transmission. Ambroxol is a secretolytic agent used in the treatment of various airway disorders. Recently, it was discovered that this compound is also an efficient sodium channel blocker with potent anti-neuropathic pain properties. We evaluated the add-on effect of ambroxol to the treatment of fibromyalgia. We studied 25 patients with fibromyalgia. Ambroxol was prescribed at the usual clinical dose of 30 mg PO 3 times a day × 1 month. At the beginning and at the end of the study, all participants filled out the Revised Fibromyalgia Impact Questionnaire (FIQ-R) and the 2010 ACR diagnostic criteria including the widespread pain index (WPI). At the end of the study, FIQ-R decreased from a baseline value of 62 ± 15 to 51 ± 19 (p = 0.013). Pain visual analogue scale decreased from 77 ± 14 to 56 ± 30 (p = 0.018). WPI diminished from 14.6 ± 3.1 to 10.4 ± 5.3 (p = 0.001). Side effects were minor. In this pilot study, the use of ambroxol was associated to decreased fibromyalgia pain and improved fibromyalgia symptoms. The open nature of our study does not allow extracting the placebo effect from the positive results. The drug was well tolerated. Ambroxol newly recognized pharmacological properties could theoretically interfere with fibromyalgia pain pathways. Dose escalating-controlled studies seem warranted.
一系列连贯的研究表明，纤维肌痛是一种由交感神经维持的神经性疼痛综合征。背根神经节钠通道可能在纤维肌痛疼痛传导中起主要作用。氨溴索是一种用于治疗各种气道疾病的黏液溶解剂。最近，发现该化合物也是一种有效的钠通道阻滞剂，具有强大的抗神经性疼痛特性。我们评估了氨溴索对纤维肌痛治疗的附加效果。我们研究了25例纤维肌痛患者。氨溴索按30mg口服，每日3次，共1个月的常规临床剂量给药。在研究开始和结束时，所有参与者填写修订的纤维肌痛影响问卷（FIQ-R）和2010年美国风湿病学会（ACR）诊断标准，包括广泛疼痛指数（WPI）。研究结束时，FIQ-R从基线值62±15降至51±19（p = 0.013）。疼痛视觉模拟量表从77±14降至56±30（p = 0.018）。WPI从14.6±3.1降至10.4±5.3（p = 0.001）。副作用较小。在这项初步研究中，使用氨溴索与纤维肌痛疼痛减轻和症状改善相关。我们研究的开放性使得无法从阳性结果中提取安慰剂效应。该药物耐受性良好。氨溴索新发现的药理特性理论上可能干扰纤维肌痛的疼痛通路。似乎有必要进行剂量递增对照研究。
