Relationships Among Pain and Depressive and Anxiety Symptoms in Clinical Trials of Pregabalin in Fibromyalgia
Relationships Among Pain and Depressive and Anxiety Symptoms in Clinical Trials of Pregabalin in Fibromyalgia
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DOI：
10.1176/appi.psy.51.6.489
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发表时间：
2010-11-01
期刊：
影响因子：
3.4
通讯作者：
Barrett, Jeannette
中科院分区：
文献类型：
--
作者：
Arnold, Lesley M.;Leon, Teresa;Barrett, Jeannette
纤维肌痛，根据美国风湿病学会的定义，其特征是广泛的疼痛持续至少3个月，当用手指压力触诊时，18个压痛点中至少有11个疼痛。目的：作者使用普瑞巴林临床试验的数据，调查了疼痛变化与焦虑和抑郁症状之间的关系。方法：汇总了三项普瑞巴林单药治疗纤维肌痛（8-14周）的双盲、安慰剂对照试验的结果，并分析了疼痛和医院焦虑抑郁量表（HADS）评分的基线至终点变化。路径分析评估了焦虑和抑郁的改善与疼痛缓解之间的关联。结果：基线HADS评分显示38%的患者有中度至重度焦虑，27%的患者有中度至重度抑郁症状。疼痛的改善与焦虑或抑郁的基线水平无关。疼痛变化与抑郁或焦虑症状之间的相关性为低至中度。路径分析显示，普瑞巴林治疗观察到的大多数疼痛缓解是直接镇痛作用，不能通过情绪改善来解释。结论：在普瑞巴林试验中，疼痛治疗的反应不依赖于焦虑或抑郁症状的基线水平，普瑞巴林改善了有或无抑郁或焦虑症状的纤维肌痛患者的疼痛。焦虑或抑郁水平的变化对疼痛减轻有低至中度的影响。普瑞巴林治疗的疼痛减轻似乎主要来自直接治疗效果，而不是通过改善焦虑或抑郁症状介导的间接效果。（Psychosomatics 2010; 51：489-497）
Fibromyalgia, as defined by the American College of Rheumatology, is characterized by widespread pain lasting for at least 3 months, with pain in at least 11 out of 18 tender points when palpated with digital pressure. Objective: The authors investigated the relationship between changes in pain and symptoms of anxiety and depression, using data from pregabalin clinical trials. Method: Results from three double-blind, placebo-controlled trials of pregabalin monotherapy in fibromyalgia (8-14 weeks) were pooled, and baseline to end-point changes in pain and Hospital Anxiety and Depression Scale ( HADS) scores were analyzed. Path-analysis evaluated the association between improvements in anxiety and depression and pain relief. Results: Baseline HADS scores indicated moderate-to-severe anxiety in 38% of patients and moderate-to-severe depressive symptoms in 27%. The improvement in pain was not related to baseline levels of anxiety or depression. The correlation between changes in pain and depressive or anxiety symptoms was low-to-moderate. Pathanalysis showed that most of the pain relief observed with pregabalin treatment was a direct analgesic effect and was not explained by improvement in mood. Conclusion: Response to treatment of pain in the pregabalin trials did not depend on baseline levels of anxiety or depressive symptoms, and pregabalin improved pain in fibromyalgia patients with or without depressive or anxiety symptoms. Changes in the level of anxiety or depression had a low-to-moderate impact on pain reduction. Pain reduction with pregabalin treatment appeared to result mostly from a direct treatment effect, rather than an indirect effect mediated through improvement in anxiety or depressive symptoms. (Psychosomatics 2010; 51:489-497)