A double-blind randomized study of clomipramine versus maprotiline in patients with idiopathic pain syndromes.
A double-blind randomized study of clomipramine versus maprotiline in patients with idiopathic pain syndromes.
复制标题
氯米帕明与马普替林治疗特发性疼痛综合征患者的双盲随机研究。
作者：
G. Eberhard;L. von Knorring;H. L. Nilsson;U. Sundequist;G. Björling;H. Linder;K. Svärd;L. Tysk
在一项为期6周的双盲、随机、多中心试验中，70例特发性综合征患者接受了去甲肾上腺素再摄取抑制剂马普替林或血清素再摄取抑制剂氯丙咪嗪的治疗。52名患者完成了双盲试验。总体而言，50%的患者病情有所改善。不仅疼痛程度显著降低，身体不适、悲伤和内心紧张程度也显著降低（由视觉模拟量表VAS确定）。睡眠障碍、智力和情绪抑制、易怒、内疚感、智力迟钝、悲伤和自杀念头的频率也有所下降（观察评分）。氯丙咪嗪治疗期间，63%的受试者表现出总体改善，而马普替林治疗期间，这一比例为36% （p < 0.05）。在氯丙帕明治疗期间，所有六项VAS评分均显著下降：悲伤、身体不适、内心紧张、注意力集中困难、记忆障碍和疼痛。在马普替林治疗期间，身体不适和疼痛明显减轻。氯丙帕明对精神焦虑和抑制（VAS）的影响也明显大于马普替林。与马普替林相比，氯丙帕明对VAS的总体降低明显更大。最重要的副作用是口干（两种药物）和出汗（氯丙咪嗪）。然而，氯丙咪嗪组有8例患者因副作用被排除，而马普替林组只有1例患者被排除。因此，结果表明抗抑郁药不仅减轻疼痛，而且在治疗特发性疼痛综合征患者中也具有临床价值。对血清素再摄取有明显作用的药物是首选。
Seventy patients with idiopathic syndromes were treated with maprotiline, a noradrenaline reuptake inhibitor, or clomipramine, a serotonin reuptake inhibitor in a 6-week, double-blind, randomized, multicenter trial. Fifty-two patients completed the double-blind phase. Overall, 50% of the patients improved. Significant decreases were seen not only in the levels of pain but also in bodily discomfort, sadness an inner tension (determined by visual analogue scales, VAS). A decrease was also found in the frequency of sleep disturbances, intellectual and emotional inhibition, irritability, guilt feelings, retardation, sadness and suicidal ideas (observed ratings). Sixty-three percent of the subjects showed an overall improvement during treatment with clomipramine as compared to 36% during treatment with maprotiline (p less than 0.05). During clomipramine treatment significant decreases were seen on all the six VAS: sadness, bodily discomfort, inner tension, concentration difficulties, memory disturbances and pain. Bodily discomfort and pain were significantly reduced during maprotiline treatment. The effects produced by clomipramine were also significantly greater than the effects caused by maprotiline as concerns psychic anxiety and inhibition (VAS). The overall reduction in VAS was significantly greater with clomipramine when compared to maprotiline. The most important side effects were dry mouth (both drugs) and sweating (clomipramine). However, in the clomipramine group, 8 patients were excluded due to side effects as compared to 1 patient in the maprotiline group. Thus, the results indicate that antidepressants reduce not only pain but are also of clinical value in the treatment of patients with idiopathic pain syndromes. Drugs with pronounced effects on the serotonin reuptake are to be preferred.