Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study.
Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study.
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DOI：
10.1111/j.1526-4637.2009.00613.x
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发表时间：
2009-05
期刊：
影响因子：
--
通讯作者：
Mackey S
中科院分区：
文献类型：
--
作者：
Younger J;Mackey S
纤维肌痛是一种慢性疼痛疾病，其特征是弥漫性肌肉骨骼疼痛和对机械刺激敏感。在这项试点临床试验中，我们测试了低剂量纳洛酮治疗纤维肌痛症状的有效性。参与者完成了一项单盲、交叉试验，时间线如下：基线（2周）、安慰剂（2周）、药物（8周）和洗脱期（2周）。10名符合纤维肌痛标准且未服用阿片类药物的女性。纳洛酮除了拮抗神经元上的阿片受体外，还抑制中枢神经系统中的小胶质细胞活性。在低剂量（4.5 mg）下，纳洛酮可抑制小胶质细胞的活性并逆转中枢和外周炎症。参与者每天使用手持电脑完成症状严重程度的报告。此外，参与者每2周访问一次实验室，测试机械，热和冷疼痛敏感性。低剂量纳洛酮减少了整个队列的纤维肌痛症状，与安慰剂相比症状减少了30%以上。此外，实验室访视显示，药物改善了机械和热痛阈值。副作用（包括失眠和生动的梦想）是罕见的，并被描述为轻微和短暂的。基线红细胞沉降率预测药物反应的方差超过80%。具有较高沉降率（表明一般炎症过程）的个体对低剂量纳洛酮的反应具有最大的症状减轻。我们的结论是，低剂量纳洛酮可能是一种有效的，高度耐受的，和廉价的治疗纤维肌痛。
Fibromyalgia is a chronic pain disorder that is characterized by diffuse musculoskeletal pain and sensitivity to mechanical stimulation. In this pilot clinical trial, we tested the effectiveness of low-dose naltrexone in treating the symptoms of fibromyalgia. Participants completed a single-blind, crossover trial with the following time line: baseline (2 weeks), placebo (2 weeks), drug (8 weeks), and washout (2 weeks). Ten women meeting criteria for fibromyalgia and not taking an opioid medication. Naltrexone, in addition to antagonizing opioid receptors on neurons, also inhibits microglia activity in the central nervous system. At low doses (4.5 mg), naltrexone may inhibit the activity of microglia and reverse central and peripheral inflammation. Participants completed reports of symptom severity everyday, using a handheld computer. In addition, participants visited the lab every 2 weeks for tests of mechanical, heat, and cold pain sensitivity. Low-dose naltrexone reduced fibromyalgia symptoms in the entire cohort, with a greater than 30% reduction of symptoms over placebo. In addition, laboratory visits showed that mechanical and heat pain thresholds were improved by the drug. Side effects (including insomnia and vivid dreams) were rare, and described as minor and transient. Baseline erythrocyte sedimentation rate predicted over 80% of the variance in drug response. Individuals with higher sedimentation rates (indicating general inflammatory processes) had the greatest reduction of symptoms in response to low-dose naltrexone. We conclude that low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia.
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