Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial.
Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial.
复制标题
DOI：
10.1186/2050-6511-15-40
复制
发表时间：
2014-07-23
影响因子：
2.9
通讯作者：
Caumo W
中科院分区：
文献类型：
--
作者：
de Zanette SA;Vercelino R;Laste G;Rozisky JR;Schwertner A;Machado CB;Xavier F;de Souza IC;Deitos A;Torres IL;Caumo W
中枢去抑制是参与纤维肌痛病理生理学的一种机制。褪黑素可以改善睡眠质量、疼痛和痛阈。我们假设单独使用褪黑激素或与阿米替林联合治疗在改变内源性疼痛调节系统（PMS）（通过条件性疼痛调节（CPM）量化）方面优于单独使用阿米替林，并且 CPM 的这种变化可能与血清脑源性神经营养因子（BDNF）有关。我们还测试了褪黑激素是否可以改善疼痛、痛阈和睡眠质量的临床症状。 63 名年龄在 18 至 65 岁之间的女性随机接受睡前阿米替林 (25 mg) (n = 21)、褪黑激素 (10 mg) (n = 21) 或褪黑激素 (10 mg) + 阿米替林 (25 mg) (n = 21)，为期六周。使用 CPM-TASK 评估下降的 PMS。评估视觉模拟量表 (VAS 0-100 mm) 的疼痛评分、纤维肌痛影响问卷 (FIQ) 评分、热痛阈值 (HPT)、睡眠质量和 BDNF 血清。 Delta值（治疗后减去治疗前）用于比较治疗效果。在开始治疗前、治疗后一周和六周收集结果变量。与单独使用阿米替林相比，单独使用褪黑素或与阿米替林联合使用可显着减轻 VAS 疼痛（P<<0.01）。阿米替林组、褪黑激素组和褪黑激素+阿米替林组的 VAS 评分增量值分别为 -12.85 (19.93)、-17.37 (18.69) 和 -20.93 (12.23)。单独使用褪黑激素和联合使用褪黑激素可增加抑制性 PMS（通过 CPM-TASK 期间数字疼痛量表 [NPS(0-10)] 减少来评估：-2.4 (2.04) 褪黑激素 + 阿米替林、-2.65 (1.68) 褪黑激素和 -1.04 (2.06) 阿米替林 (P < 0.05)。褪黑激素+阿米替林治疗在 FIQ 和 PPT 改善方面比单独使用褪黑激素和阿米替林显示出更好的结果（P<0.05，两者均适用）。通过 CPM-TASK 期间 NPS(0-10) 的减少来评估，褪黑激素增加了抑制性内源性疼痛调节系统。单独使用褪黑激素或与阿米替林联用在改善 VAS 疼痛方面优于单独使用阿米替林，而与阿米替林联用仅对 FIQ 和 PPT 产生边际额外临床效果。目前的对照试验已在 Clinical Trials.gov 上注册，注册号为 NCT02041455。 2014年1月16日注册。
Central disinhibition is a mechanism involved in the physiopathology of fibromyalgia. Melatonin can improve sleep quality, pain and pain threshold. We hypothesized that treatment with melatonin alone or in combination with amitriptyline would be superior to amitriptyline alone in modifying the endogenous pain-modulating system (PMS) as quantified by conditional pain modulation (CPM), and this change in CPM could be associated with serum brain-derived neurotrophic factor (BDNF). We also tested whether melatonin improves the clinical symptoms of pain, pain threshold and sleep quality. Sixty-three females, aged 18 to 65, were randomized to receive bedtime amitriptyline (25 mg) (n = 21), melatonin (10 mg) (n = 21) or melatonin (10 mg) + amitriptyline (25 mg) (n = 21) for a period of six weeks. The descending PMS was assessed with the CPM-TASK. It was assessed the pain score on the Visual Analog Scale (VAS 0-100 mm), the score on Fibromyalgia Impact Questionnaire (FIQ), heat pain threshold (HPT), sleep quality and BDNF serum. Delta values (post- minus pre-treatment) were used to compare the treatment effect. The outcomes variables were collected before, one and six weeks after initiating treatment. Melatonin alone or in combination with amitriptyline reduced significantly pain on the VAS compared with amitriptyline alone (P < 0.01). The delta values on the VAS scores were-12.85 (19.93),-17.37 (18.69) and-20.93 (12.23) in the amitriptyline, melatonin and melatonin+amitriptyline groups, respectively. Melatonin alone and in combination increased the inhibitory PMS as assessed by the Numerical Pain Scale [NPS(0-10)] reduction during the CPM-TASK:-2.4 (2.04) melatonin + amitriptyline,-2.65 (1.68) melatonin, and-1.04 (2.06) amitriptyline, (P < 0.05). Melatonin + amitriptyline treated displayed better results than melatonin and amitriptyline alone in terms of FIQ and PPT improvement (P < 0.05, fort both). Melatonin increased the inhibitory endogenous pain-modulating system as assessed by the reduction on NPS(0-10) during the CPM-TASK. Melatonin alone or associated with amitriptyline was better than amitriptyline alone in improving pain on the VAS, whereas its association with amitriptyline produced only marginal additional clinical effects on FIQ and PPT. Current controlled trail is registered at clinical trials.gov upon under number NCT02041455. Registered January 16, 2014.
登录
查看更多内容
影响因子：
4.9
作者：
Bendtsen, L;Jensen, R
通讯作者：
Jensen, R
影响因子：
5.3
作者：
Arnold, Lesley M.;Hudson, James I.;Hess, Evelyn V.
通讯作者：
Hess, Evelyn V.
影响因子：
5
作者：
Detanico, Bernardo C.;Piato, Angelo L.;Elisabetsky, Elaine
通讯作者：
Elisabetsky, Elaine
影响因子：
5.3
作者：
Genoud, C;Knott, GW;Welker, E
通讯作者：
Welker, E
影响因子：
7.6
作者：
DAO, TTT;LAVIGNE, GJ;LUND, JP
通讯作者：
LUND, JP