Nicolodi M, Sicuteri F
Interuniversity Centre of Neurochemistry, University Unit, Florence, Italy.
Adv Exp Med Biol. 1996;398:373-9. doi: 10.1007/978-1-4613-0381-7_58.
In this study fibromyalgia sufferers were randomly administered a combination of monoamine-oxidase inhibitors (MAOIs)-A/B with 5-HTP, 5-HTP alone, MAOIs-A/B alone, or the tricyclic drug amitriptyline in order to compare the efficacy of these treatments. The benefits on the painful syndrome were assessed by using Visual Analogic Scale score rating from 0 to 4. The combination of MAOIs with 5-HTP significantly improved fibromyalgia syndrome as determined by Visual Analogic Scale whereas the other treatments yielded poorer benefits. No subject withdrew from the trial due to adverse effects, even if some sleep disturbances and mild stomach-ache were reported. The tolerability of the association MAOIs/5-HTP was good, although a transient cheese effect occurred in one of the patients treated with MAOIs as well as in a patient treated with the association MAOIs and 5-HTP. No one of these two cases was due to pharmacological dietetic mistake of the patient. In both the cases the transient hypertension was associated to very dramatic emotional events. The benefits obtained by using the combination of MAOIs with 5-HTP can be explained with a treatment-induced enhancement of aminergic and serotonergic transmission. The recently shown high prevalence of migraine in the population of fibromyalgia sufferers, suggests a common ground shared by fibromyalgia and migraine. Migraine has been demonstrated to be characterized by a defect in the serotonergic and adrenergic systems. A parallel dramatic failure of serotonergic systems and a defect of adrenergic transmission have been evidenced to affect fibromyalgia sufferers too. Enhancing serotonergic analgesia while increasing adrenergically mediated analgesia seems to be an important tool in fibromyalgia. Treatment consisting with the association MAOIs/5-HTP is aimed at enhancing serotonergic/adrenergic transmission by inducing an up-regulation of serotonergic/adrenergic receptors and a simultaneous increase of serotonin levels in the central nervous system.
在本研究中，纤维肌痛患者被随机给予单胺氧化酶抑制剂（MAOIs）A/B与5-羟色氨酸（5-HTP）的组合、单独的5-HTP、单独的MAOIs-A/B或三环类药物阿米替林，以比较这些治疗方法的疗效。通过使用0至4的视觉模拟评分量表来评估对疼痛综合征的益处。MAOIs与5-HTP的组合通过视觉模拟量表显示能显著改善纤维肌痛综合征，而其他治疗的益处较差。没有受试者因不良反应退出试验，尽管有一些睡眠障碍和轻微胃痛的报告。MAOIs/5-HTP组合的耐受性良好，尽管在一名接受MAOIs治疗的患者以及一名接受MAOIs和5-HTP联合治疗的患者中出现了短暂的酪胺效应。这两例均不是由于患者的药物饮食错误导致的。在这两例中，短暂性高血压均与非常剧烈的情绪事件有关。使用MAOIs与5-HTP组合所获得的益处可以用治疗引起的胺能和5-羟色胺能传递增强来解释。最近在纤维肌痛患者群体中显示出的偏头痛高患病率，表明纤维肌痛和偏头痛有共同基础。偏头痛已被证明其特征在于5-羟色胺能和肾上腺素能系统存在缺陷。已经证明，5-羟色胺能系统的平行显著功能障碍和肾上腺素能传递缺陷也会影响纤维肌痛患者。增强5-羟色胺能镇痛作用同时增加肾上腺素能介导的镇痛作用似乎是纤维肌痛治疗中的一个重要手段。由MAOIs/5-HTP组合组成的治疗旨在通过诱导5-羟色胺能/肾上腺素能受体的上调以及同时增加中枢神经系统中的5-羟色胺水平来增强5-羟色胺能/肾上腺素能传递。
