Lawson Kim
Department of Biosciences and Chemistry, Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK.
Biomedicines. 2017 May 17;5(2):24. doi: 10.3390/biomedicines5020024.
Fibromyalgia is a complex chronic condition characterized by pain, physical fatigue, sleep disorder and cognitive impairment. Evidence-based guidelines recommend antidepressants as treatments of fibromyalgia where tricyclics are often considered to have the greatest efficacy, with amitriptyline often being a first-line treatment. Amitriptyline evokes a preferential reduction in pain and fatigue of fibromyalgia, and in the Fibromyalgia Impact Questionnaire (FIQ) score, which is a quality of life assessment. The multimodal profile of the mechanisms of action of amitriptyline include monoamine reuptake inhibition, receptor modulation and ion channel modulation. Several of the actions of amitriptyline on multiple nociceptive and sensory processes at central and peripheral locations have the potential to act cumulatively to suppress the characteristic symptoms of fibromyalgia. Greater understanding of the role of these mechanisms of action of amitriptyline could provide further clues to the pathophysiology of fibromyalgia and to a preferable pharmacological profile for future drug development.
纤维肌痛是一种复杂的慢性疾病，其特征为疼痛、身体疲劳、睡眠障碍和认知障碍。循证指南推荐使用抗抑郁药治疗纤维肌痛，其中三环类药物通常被认为疗效最佳，阿米替林常作为一线治疗药物。阿米替林能优先减轻纤维肌痛的疼痛和疲劳，并降低纤维肌痛影响问卷（FIQ）评分，该评分是一种生活质量评估。阿米替林的多模式作用机制包括单胺再摄取抑制、受体调节和离子通道调节。阿米替林对中枢和外周多个伤害性和感觉过程的多种作用有可能累积起来，从而抑制纤维肌痛的特征性症状。更深入了解阿米替林这些作用机制的作用，可能为纤维肌痛的病理生理学以及未来药物研发的更佳药理学特征提供进一步线索。
