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首页> 外文期刊>Prescrire international >Fibromyalgia: poorly understood; treatments are disappointing.
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Fibromyalgia: poorly understood; treatments are disappointing.

机译：纤维肌痛：了解甚少;治疗令人失望。

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(1) Fibromyalgia is characterised by a range of symptoms that include muscle pain, fatigue and sleep disorders. Anxiety and depression are often also present. The cause is unknown. More women than men are affected; (2) The following review focuses on differential diagnoses and available treatments for fibromyalgia, based on a review of the literature using the standard Prescrire methodology; (3) Fibromyalgia is mainly diagnosed by excluding other possibilities. The principal differential diagnoses are rheumatic involvement of the spine, systemic inflammatory disorders, and hypothyroidism. Unlike these other conditions, fibromyalgia is not associated with radiological or laboratory abnormalities; (4) Paracetamol has not been compared with other treatments in fibromyalgia. Nonsteroidal antiinflammatory drugs have no specific effect; (5) The only two trials assessing tramadol showed little effect; in one study the average pain score was 53 mm in the tramadol group versus 65 mm in the placebo group, on a scale ranging from 0 to 100 mm. The adverse effects of tramadol are those of opiates in general, mainly nausea and dependence. Tramadol interacts with numerous other drugs; (6) The efficacy of tricyclic antidepressants is also difficult to quantify. Their limited superiority over placebo lasts no more than a few months. The efficacy of selective serotonin reuptake inhibitor antidepressants (fluoxetine, paroxetine and citalopram), serotonin and nonadrenaline reuptake inhibitors (duloxetine and milnacipran) is even less well established. Duloxetine has been tested in four placebo-controlled trials with unconvincing results; (7) Pregabalin and gabapentin, two antiepileptic drugs, appear to be more effective than placebo but have only been tested in short-term trials. In one trial 44% of patients in the pregabalin group said they felt better after 13 weeks versus 35% of patients in the placebo group. However, adverse effects are frequent and sometimes troublesome (drowsiness, dizziness, nausea, weight gain). In clinical trials, 19% to 33% of patients stopped treatment due to adverse effects after 13 weeks, depending on the dose of pregabalin; (8) Assessments of non-drug treatments in this setting are generally mediocre. The best-assessed alternative therapies (acupuncture and physical exercise) only have a limited effect; (9) In practice, when a patient presents with symptoms compatible with fibromyalgia, the first step is to rule out a treatable condition. Quality of life may be improved by first acknowledging that the pain is real, and possibly by providing psychological, medical, social and occupational support. The limited efficacy of available drugs, and their potential adverse effects, should be discussed with the patient.
机译：（1）纤维肌痛的特征是一系列症状，包括肌肉疼痛，疲劳和睡眠障碍。焦虑和抑郁也经常出现。原因未知。妇女多于男子。 （2）以下综述基于使用标准Prescrire方法的文献综述，着重于纤维肌痛的鉴别诊断和可用治疗; （3）纤维肌痛主要通过排除其他可能性来诊断。主要的鉴别诊断是风湿性脊柱受累，全身性炎症和甲状腺功能减退。与这些其他情况不同，纤维肌痛与放射学或实验室异常无关。 （4）扑热息痛尚未与纤维肌痛的其他治疗方法进行比较。非甾体类抗炎药没有特异性作用。 （5）仅有两项评估曲马多的试验效果不佳;在一项研究中，曲马多组的平均疼痛评分为53毫米，而安慰剂组为65毫米，评分范围为0至100毫米。曲马多的不良反应通常是鸦片剂的不良反应，主要是恶心和依赖性。曲马多可与多种其他药物相互作用。 （6）三环类抗抑郁药的疗效也难以量化。它们相对于安慰剂的有限优势持续不超过几个月。选择性5-羟色胺再摄取抑制剂抗抑郁药（氟西汀，帕罗西汀和西酞普兰），5-羟色胺和非肾上腺素再摄取抑制剂（度洛西汀和米那普仑）的疗效尚不明确。度洛西汀已经在四项安慰剂对照试验中进行了测试，结果令人信服。 （7）两种抗癫痫药普瑞巴林和加巴喷丁似乎比安慰剂更有效，但仅在短期试验中进行过测试。在一项试验中，普瑞巴林组中有44％的患者表示13周后感觉好转，而安慰剂组中为35％。但是，不良反应很常见，有时还会很麻烦（嗜睡，头晕，恶心，体重增加）。在临床试验中，有19％至33％的患者在13周后由于不良反应而停止治疗，具体取决于普瑞巴林的剂量。 （8）在这种情况下，非药物治疗的评估通常是中等的。评估最好的替代疗法（针灸和体育锻炼）效果有限。 （9）实际上，当患者出现与纤维肌痛相适应的症状时，第一步是排除可治疗的疾病。通过首先确认疼痛是真实的，并可能通过提供心理，医学，社会和职业支持，可以改善生活质量。可用药物的疗效有限，及其潜在的不良反应，应与患者讨论。

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    《Prescrire international》 |2009年第102期|共5页
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  • 中图分类 药学;
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