Fishbain D A, Cutler R B, Rosomoff H L, Rosomoff R S
Department of Psychiatry, University of Miami School of Medicine, University of Miami Comprehensive Pain & Rehabilitation Center, at South Shore Hospital, South Miami Beach, Florida 33319, USA.
Psychosom Med. 1998 Jul-Aug;60(4):503-9. doi: 10.1097/00006842-199807000-00019.
A significant amount of evidence indicates that some antidepressants have an analgesic effect. We wished to determine whether this analgesic effect could be demonstrated in studies that had used antidepressants for the treatment of pain in patients diagnosed with psychogenic pain or somatoform pain disorder. Meta-analysis was used for this purpose.
All randomized, placebo-controlled antidepressant treatment studies of patients diagnosed with psychogenic pain disorder or somatoform pain disorder were isolated. These studies were reviewed and relevant statistics were coded. For each study, a single p value for the drug/placebo comparison was found or calculated for pain change scores from pretreatment to completion of treatment. The z scores and effect sizes were calculated for each study, followed by a calculation of an overall z score and effect size.
Eleven studies fulfilled the inclusion and exclusion criteria for this meta-analysis. The combined difference showed that antidepressants decreased pain intensity in patients with psychogenic pain or somatoform pain disorder significantly more than placebo (z = 5.71, p<.0001). The overall effect size was large (mean = 0.48) and ranged from 0 to 0.91.
The results indicate that, in patients diagnosed with psychogenic pain or somatoform pain disorder, antidepressant treatment resulted in a reduction in pain that was significantly greater than that of placebo. Possible explanations for these results are discussed.
大量证据表明某些抗抑郁药具有镇痛作用。我们希望确定在使用抗抑郁药治疗诊断为精神性疼痛或躯体形式疼痛障碍患者的疼痛的研究中，是否能证实这种镇痛作用。为此采用了荟萃分析。
筛选出所有诊断为精神性疼痛障碍或躯体形式疼痛障碍患者的随机、安慰剂对照抗抑郁药治疗研究。对这些研究进行综述并对相关统计数据进行编码。对于每项研究，找到或计算从治疗前到治疗结束疼痛变化评分的药物/安慰剂比较的单个p值。计算每项研究的z分数和效应大小，随后计算总体z分数和效应大小。
11项研究符合该荟萃分析的纳入和排除标准。综合差异表明，抗抑郁药使精神性疼痛或躯体形式疼痛障碍患者的疼痛强度降低幅度明显大于安慰剂（z = 5.71，p <.0001）。总体效应大小较大（平均值 = 0.48），范围为0至0.91。
结果表明，在诊断为精神性疼痛或躯体形式疼痛障碍的患者中，抗抑郁药治疗导致的疼痛减轻明显大于安慰剂。讨论了这些结果的可能解释。
