J Oral Facial Pain Headache. 2019 Winter;33(1):7–13. doi: 10.11607/ofph.1886. Epub 2018 Aug 20.
To evaluate and compare the pharmacotherapeutic efficacies of two tricyclic antidepressant (TCA) drugs for masticatory myofascial pain (MFP): nortriptyline (NOR) and amitriptyline (AMI).
Fifty patients with chronic MFP were included in the study; 30 were medicated with AMI only, and 20 took NOR after discontinuing AMI due to adverse effects. Pain diaries recording verbal pain scores (VPS) were utilized to compare posttreatment scores to baseline scores. Chi-square and t tests were used to analyze the data.
Across both groups, the mean ± standard deviation VPS score at the end of treatment (2.92 ± 3.2) was significantly lower compared to baseline (6.4 ± 1.75; P < .0001) and was a clinically meaningful (≥ 50%) difference. Initial VPS scores were similar in the AMI and NOR groups (6.27 ± 1.92 and 6.78 ± 1.98). At the end of the study, NOR patients reported a lower final VPS compared to AMI patients (2.83 ± 3.06 vs 4.55 ± 2.92; P = .039). The 50% improvement rate with NOR treatment was better than with AMI treatment (P = .036). The same maximal dosages were used by the patients who achieved a ≥ 50% success rate (20.96 ± 5.036 mg) than those who did not (21.667 ± 5.036 mg).
TCAs are effective in reducing pain in patients with chronic MFP. NOR seems more effective and better tolerated than AMI, but due to study limitations, more data are needed to confirm these results.
评估和比较两种三环类抗抑郁药（TCA）药物治疗咀嚼肌筋膜疼痛（MFP）的药效：去甲替林（NOR）和阿米替林（AMI）。
本研究纳入了 50 例慢性 MFP 患者；其中 30 例仅服用 AMI 治疗，20 例因不良反应停用 AMI 后改用 NOR。利用疼痛日记记录口述疼痛评分（VPS），比较治疗后评分与基线评分。采用卡方检验和 t 检验进行数据分析。
两组患者的治疗结束时 VPS 评分均值±标准差（2.92±3.2）均显著低于基线时（6.4±1.75；P＜0.0001），差异具有临床意义（≥50%）。AMI 组和 NOR 组患者的初始 VPS 评分相似（6.27±1.92 和 6.78±1.98）。研究结束时，NOR 组患者的最终 VPS 评分低于 AMI 组（2.83±3.06 比 4.55±2.92；P=0.039）。NOR 治疗的 50%改善率优于 AMI 治疗（P=0.036）。达到≥50%成功率的患者与未达到该成功率的患者所使用的最大剂量相同（20.96±5.036 mg 比 21.667±5.036 mg）。
TCA 可有效减轻慢性 MFP 患者的疼痛。NOR 似乎比 AMI 更有效且更耐受，但由于研究限制，需要更多数据来证实这些结果。
