Stauffer J D
J Fam Pract. 1987 Aug;25(2):167-70.
Successful treatment of pain syndromes is one of the most common and most difficult problems facing family physicians. Frequently analgesics provide inadequate treatment, and clinicians are forced to consider alternatives. This article reviews the neurophysiologic similarities between depression and the chronic pain syndromes and describes several well-designed double-blinded studies that give evidence for the efficacy of antidepressants in chronic pain syndromes. These studies conclude that antidepressants should be considered in chronic pain syndromes that do not respond to analgesics. For chronic pain, antidepressants should be started at a low dosage and increased in a stepwise manner until an improvement in the pain occurs or intolerable side effects intervene. Side effects are a bothersome aspect of antidepressant therapy but are more tolerable at the doses generally needed for pain relief than at antidepressive doses. At least three weeks of antidepressant therapy is generally needed to gain significant relief of symptoms.
疼痛综合征的成功治疗是家庭医生面临的最常见且最棘手的问题之一。通常，镇痛药的治疗效果并不理想，临床医生不得不考虑其他治疗方法。本文回顾了抑郁症与慢性疼痛综合征之间的神经生理学相似性，并描述了几项精心设计的双盲研究，这些研究为抗抑郁药治疗慢性疼痛综合征的疗效提供了证据。这些研究得出结论，对于对镇痛药无反应的慢性疼痛综合征，应考虑使用抗抑郁药。对于慢性疼痛，抗抑郁药应从小剂量开始，逐步增加剂量，直至疼痛有所改善或出现无法耐受的副作用。副作用是抗抑郁药治疗中令人困扰的一个方面，但在缓解疼痛所需的一般剂量下，比在抗抑郁剂量下更易耐受。通常至少需要三周的抗抑郁药治疗才能显著缓解症状。
