Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache
Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache
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DOI：
10.1046/j.1468-2982.2000.00087.x
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发表时间：
2000-07-01
期刊：
影响因子：
4.9
通讯作者：
Jensen, R
中科院分区：
文献类型：
--
作者：
Bendtsen, L;Jensen, R
三环类抗抑郁药阿米替林广泛用于治疗慢性紧张型头痛。本研究的目的是调查镇痛效果是由肌肉疼痛减轻还是由疼痛敏感性普遍降低引起的。在一项为期 32 周、双盲、安慰剂对照、三向交叉研究中，33 名患有慢性紧张型头痛的非抑郁患者接受阿米替林 75 毫克/天和高选择性血清素再摄取抑制剂西酞普兰 20 毫克/天的治疗。在每个治疗期结束时，记录实际头痛强度和颅周肌筋膜压痛，测量手指和颞区的压痛检测和耐受阈值，并测量唇连合处的电痛阈值。阿米替林比安慰剂更能显着降低压痛和头痛强度（分别为 P = 0.01 和 P = 0.04）。压痛的减少可完全归因于对阿米替林治疗有反应的患者组，头痛减少了至少 30%，而无反应者的压痛没有变化。阿米替林不影响任何检查部位的压力或电痛阈值。西酞普兰对任何检查参数都没有显着影响。这些发现表明，阿米替林通过减少肌筋膜组织疼痛刺激的传递而不是降低整体疼痛敏感性来对慢性肌筋膜疼痛产生镇痛作用。我们认为这种效应是由中枢敏化的节段性减少与外周抗伤害作用相结合引起的。
The tricyclic anti-depressant amitriptyline is widely used in the treatment of chronic tension-type headache. The aim of the present study was to investigate whether the analgesic effect is caused by a reduction of muscle pain or by a general reduction of pain sensitivity. Thirty-three non-depressed patients with chronic tension-type headache were treated with amitriptyline 75 mg/day and with the highly selective serotonin reuptake inhibitor citalopram 20 mg/day in a 32-week, double-blind, placebo-controlled, three-way crossover study. At the end of each treatment period, actual headache intensity and pericranial myofascial tenderness were recorded, pressure pain detection and tolerance thresholds were measured in the finger and in the temporal region and the electrical pain threshold was measured at the labial commissure. Amitriptyline reduced tenderness and headache intensity significantly more than placebo (P = 0.01 and P = 0.04, respectively). The reduction in tenderness could be ascribed solely to the group of patients who responded to amitriptyline treatment by at least 30% reduction in headache while tenderness was unchanged in non-responders. Amitriptyline did not affect pressure or electrical pain thresholds at any of the examined locations. Citalopram had no significant effect on any of the examined parameters. These findings indicate that amitriptyline elicits its analgesic effect in chronic myofascial pain by reducing the transmission of painful stimuli from myofascial tissues rather than by reducing overall pain sensitivity. We suggest that this effect is caused by a segmental reduction of central sensitization in combination with a peripheral anti-nociceptive action.