Segregating the Cerebral Mechanisms of Antidepressants and Placebo in Fibromyalgia

被引:17
作者
Jensen, Karin B. [1 ,2 ]
Petzke, Frank [3 ]
Carville, Serena [4 ]
Choy, Ernest [5 ]
Fransson, Peter [6 ]
Gracely, Richard H. [7 ]
Vitton, Olivier [8 ]
Marcus, Hanke [9 ]
Williams, Steven C. R. [10 ]
Ingvar, Martin [6 ,11 ]
Kosek, Eva [6 ,11 ]
机构
[1] Harvard Univ, Sch Med, Massachusetts Gen Hosp, Dept Psychiat, Boston, MA 02115 USA
[2] Athinoula Martinos Ctr Biomed Imaging, Boston, MA USA
[3] Univ Hosp, Ctr Anesthesiol Emergency & Intens Care Med, Gottingen, Germany
[4] Royal Coll Physicians, Natl Clin Guideline Ctr, London NW1 4LE, England
[5] Cardiff Univ, Sch Med, Cardiff CF10 3AX, S Glam, Wales
[6] Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden
[7] Univ N Carolina, Ctr Neurosensory Disorders, Chapel Hill, NC USA
[8] Pierre Fabre, Boulogne, France
[9] Univ Cologne, Dept Anesthesiol & Postoperat Intens Care Med, Cologne, Germany
[10] Kings Coll London, Inst Psychiat, Ctr Neuroimaging Sci, London WC2R 2LS, England
[11] Karolinska Inst, Osher Ctr Integrat Med, Stockholm, Sweden
关键词
Antidepressive agents; fibromyalgia; milnacipran; magnetic resonance imaging; placebos; DEFAULT-MODE NETWORK; DOUBLE-BLIND; PAIN MODULATION; BRAIN; DULOXETINE; OSTEOARTHRITIS; SENSITIVITY; MILNACIPRAN; EFFICACY;
D O I
10.1016/j.jpain.2014.09.011
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Antidepressant drugs are commonly used to treat fibromyalgia, but there is little knowledge about their mechanisms of action. The aim of this study was to compare the cerebral and behavioral response to positive treatment effects of antidepressants or placebo. Ninety-two fibromyalgia patients participated in a 12-week, double-blind, placebo-controlled clinical trial with milnacipran, a serotonin-norepinephrine reuptake inhibitor. Before and after treatment, measures of cerebral pain processing were obtained using functional magnetic resonance imaging. Also, there were stimulus response assessments of pressure pain, measures of weekly pain, and fibromyalgia impact. Following treatment, milnacipran responders exhibited significantly higher activity in the posterior cingulum compared with placebo responders. The mere exposure to milnacipran did not explain our findings because milnacipran responders exhibited increased activity also in comparison to milnacipran nonresponders. Stimulus response assessments revealed specific antihyperalgesic effects in milnacipran responders, which was also correlated with reduced clinical pain and with increased activation of the posterior cingulum. A short history of pain predicted positive treatment response to milnacipran. We report segregated neural mechanisms for positive responses to treatment with milnacipran and placebo, reflected in the posterior cingulum. The increase of pain-evoked activation in the posterior cingulum may reflect a normalization of altered default mode network processing, an alteration implicated in fibromyalgia pathophysiology. Perspective: This study presents neural and psychophysical correlates to positive treatment responses in patients with fibromyalgia, treated with either milnacipran or placebo. The comparison between placebo responders and milnacipran responders may shed light on the specific mechanisms involved in antidepressant treatment of chronic pain. (C) 2014 by the American Pain Society
引用
收藏
页码:1328 / 1337
页数:10
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