Sharav Yair, Singer Elyse, Schmidt Elizabeth, Dionne Raymond A, Dubner Ronald
Pain Research Clinic, Neurobiology and Anesthesiology Branch, National Institute of Dental Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892 U.S.A. Department of Oral Diagnosis, Oral Medicine and Oral Radiology, Hebrew University - Hadassah School of Dental Medicine, JerusalemIsrael.
Pain. 1987 Nov;31(2):199-209. doi: 10.1016/0304-3959(87)90036-4.
The efficacy of amitriptyline was evaluated in 28 patients with chronic oral-facial pain. Most of the patients had evidence of musculoskeletal pain while some had a history suggesting pain of neurogenic origin. Two patients had mixed elements of neurogenic and musculoskeletal pain. Amitriptyline was more effective than placebo in reducing pain after 4 weeks of treatment. No effect was found after only 1 week of drug administration in either dose range. When the patients were divided into depressed and non-depressed groups based on their Hamilton depression scores, amitriptyline reduced pain in the depressed and in the non-depressed groups as compared to placebo. Amitriptyline reduced the depression scores in the depressed group but had no effect on the depression scores in the non-depressed group. Thus, pain reduction was not associated with a change in mood in the non-depressed group. Amitriptyline had no effect on patients' ratings of the intensity of experimental heat stimuli. We conclude that amitriptyline is effective in the treatment of chronic oral-facial pain and that its efficacy is independent of its effects on depression. It appears that tricyclic antidepressants act in a fashion different from opiate drugs that alter the sensory discriminative component of pain.
对28例慢性口腔面部疼痛患者的阿米替林疗效进行了评估。大多数患者有肌肉骨骼疼痛的证据，而一些患者有提示神经源性疼痛的病史。两名患者同时存在神经源性和肌肉骨骼疼痛的混合症状。治疗4周后，阿米替林在减轻疼痛方面比安慰剂更有效。在任一剂量范围内，仅给药1周后均未发现效果。根据汉密尔顿抑郁量表评分将患者分为抑郁组和非抑郁组，与安慰剂相比，阿米替林在抑郁组和非抑郁组中均减轻了疼痛。阿米替林降低了抑郁组的抑郁评分，但对非抑郁组的抑郁评分没有影响。因此，非抑郁组的疼痛减轻与情绪变化无关。阿米替林对患者对实验性热刺激强度的评分没有影响。我们得出结论，阿米替林在治疗慢性口腔面部疼痛方面有效，其疗效与其对抑郁的影响无关。三环类抗抑郁药的作用方式似乎与改变疼痛感觉辨别成分的阿片类药物不同。
