Pain Relief in Depressive Disorders A Meta-Analysis of the Effects of Antidepressants
Pain Relief in Depressive Disorders A Meta-Analysis of the Effects of Antidepressants
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DOI：
10.1097/jcp.0000000000000604
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发表时间：
2016-12-01
影响因子：
2.9
通讯作者：
Koenig, Udo
中科院分区：
文献类型：
--
作者：
Gebhardt, Stefan;Heinzel-Gutenbrunner, Monika;Koenig, Udo
背景：疼痛是抑郁症患者的常见症状，如果存在，则会恶化预后。然而，关于抗抑郁药对抑郁障碍患者痛苦的身体症状的治疗效果的经验知识很少。此外，三环/四环类抗抑郁药(TCA)尚未纳入现有的荟萃分析。方法：对PubMed中有关抗抑郁药治疗伴有疼痛症状的抑郁障碍患者的文献进行广泛、系统的检索。结果：14项安慰剂对照研究包括选择性5-羟色胺-去甲肾上腺素再摄取抑制剂(SSNRIs)，其中3项研究也研究了选择性5-羟色胺再摄取抑制剂(SSRIs)。另外三项安慰剂对照的SSRI研究被确定，但只有两项安慰剂对照的TCA研究。SSNRIs和SSRIs，但不是TCA，在其止痛效果方面明显优于安慰剂。然而，所有的影响都很小。SSNRIs的止痛效果与其对患者情绪的积极作用呈显著正相关。讨论：SSNRIs和SSRIs在原发性抑郁障碍患者中的止痛效果基本相同。由于缺乏安慰剂对照的TCA研究，如果纳入非安慰剂对照的TCA研究，TCA的结果将仅与SSRIs和SSNRIs的结果可比。这种正相关关系表明，止痛与抗抑郁治疗效果密切相关。这些结果仅涉及患有原发性抑郁障碍的患者，而不涉及患有原发性疼痛障碍的患者。进一步研究比较不同类型的抗抑郁药物对抑郁症患者疼痛的影响是有必要的。
Background: Pain is a common symptom in patients with depressive disorders, which, if present, worsens the prognosis. However, there is little empirical knowledge of the therapeutic effects of antidepressants on painful physical symptoms of patients with depressive disorders. Furthermore, tricyclic/tetracyclic antidepressants (TCAs) have not yet been included in existing meta-analyses.Methods: A broad, systematic search of PubMed literature on antidepressant drug treatment of patients with depressive disorders with comorbid pain symptoms was carried out. A random-effects meta-analysis has been performed among 3 different groups of drugs for the 2 end points: pain and depression.Results: Fourteen placebo-controlled studies with selective serotonin-noradrenaline reuptake inhibitors (SSNRIs) could be included, with 3 of them also investigating selective serotonin reuptake inhibitors (SSRIs). Three further placebo-controlled SSRI studies were identified, but only 2 placebo-controlled TCA studies. Both SSNRIs and SSRIs, but not TCAs, were significantly superior to placebo as regards their analgesic effects. However, all effects were small. For SSNRIs, there was a strong positive correlation between their effectiveness for pain relief and their positive effect on the mood of the patients.Discussion: The analgesic effects of SSNRIs and SSRIs in patients with primary depressive disorders can be interpreted as largely equivalent. Because of a lack of placebo-controlled TCA studies, the results for TCAs would be comparable only to those of SSRIs and SSNRIs, if non-placebo-controlled TCA studies were included. The positive correlation found indicates a close relationship of pain relief and antidepressant treatment effects. These results refer merely to patients with primary depressive disorders, not to patients with primary pain disorders. Further studies comparing the effects of different types of antidepressant drugs on pain in depressive patients are warranted.