Cargando…

Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study

INTRODUCTION: Fibromyalgia is characterized by widespread and chronic pain, and its prevalence is increasing worldwide. Milnacipran, an antidepressant, is often prescribed for fibromyalgia with a possible beneficial effect on central pain modulation. The aim of this study was to evaluate if milnacip...

Descripción completa

Detalles Bibliográficos
Autores principales: Pickering, Gisèle, Macian, Nicolas, Delage, Noémie, Picard, Pascale, Cardot, Jean-Michel, Sickout-Arondo, Sophia, Giron, Fatiha, Dualé, Christian, Pereira, Bruno, Marcaillou, Fabienne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089099/
https://www.ncbi.nlm.nih.gov/pubmed/30127596
http://dx.doi.org/10.2147/DDDT.S162810
_version_ 1783346962504876032
author Pickering, Gisèle
Macian, Nicolas
Delage, Noémie
Picard, Pascale
Cardot, Jean-Michel
Sickout-Arondo, Sophia
Giron, Fatiha
Dualé, Christian
Pereira, Bruno
Marcaillou, Fabienne
author_facet Pickering, Gisèle
Macian, Nicolas
Delage, Noémie
Picard, Pascale
Cardot, Jean-Michel
Sickout-Arondo, Sophia
Giron, Fatiha
Dualé, Christian
Pereira, Bruno
Marcaillou, Fabienne
author_sort Pickering, Gisèle
collection PubMed
description INTRODUCTION: Fibromyalgia is characterized by widespread and chronic pain, and its prevalence is increasing worldwide. Milnacipran, an antidepressant, is often prescribed for fibromyalgia with a possible beneficial effect on central pain modulation. The aim of this study was to evaluate if milnacipran could modify the status of conditioned pain modulation (CPM) in patients suffering from fibromyalgia. DESIGN AND SETTING: Randomized, double-blind controlled trial. SUBJECTS AND METHODS: Women with fibromyalgia received milnacipran 100 mg or placebo. The primary end point was the evolution of CPM with treatments after a 30-second painful stimulus. Secondary outcomes included the predictability of milnacipran efficacy from CPM performance, evolution of global pain, mechanical sensitivity, thermal pain threshold, mechanical allodynia, cognitive function, and tolerance. RESULTS: Fifty-four women with fibromyalgia (46.7±10.6 years) were included and randomized, and 24 patients were analyzed in each group. At inclusion, CPM was dysfunctional (CPM(30)=−0.5±1.9), and global pain was 6.5±1.8. After treatment, there was a nonsignificant CPM difference between milnacipran and placebo (CPM(30)=−0.46±1.22 vs −0.69±1.43, respectively, p=0.55) and 18.8% vs 6.3% (p=0.085) patients did reactivate CPM after milnacipran vs placebo. Initial CPM was not a predictor of milnacipran efficacy. Global pain, mechanical and thermal thresholds, allodynia, cognition, and tolerance were not significantly different between both groups. CONCLUSION: Milnacipran did not display a significant analgesic effect after 1-month treatment, but the tendency of milnacipran to reactivate CPM in a number of patients must be explored with longer treatment duration in future studies and pleads for possible subtypes of fibromyalgia patients.
format Online
Article
Text
id pubmed-6089099
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Dove Medical Press
record_format MEDLINE/PubMed
spelling pubmed-60890992018-08-20 Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study Pickering, Gisèle Macian, Nicolas Delage, Noémie Picard, Pascale Cardot, Jean-Michel Sickout-Arondo, Sophia Giron, Fatiha Dualé, Christian Pereira, Bruno Marcaillou, Fabienne Drug Des Devel Ther Original Research INTRODUCTION: Fibromyalgia is characterized by widespread and chronic pain, and its prevalence is increasing worldwide. Milnacipran, an antidepressant, is often prescribed for fibromyalgia with a possible beneficial effect on central pain modulation. The aim of this study was to evaluate if milnacipran could modify the status of conditioned pain modulation (CPM) in patients suffering from fibromyalgia. DESIGN AND SETTING: Randomized, double-blind controlled trial. SUBJECTS AND METHODS: Women with fibromyalgia received milnacipran 100 mg or placebo. The primary end point was the evolution of CPM with treatments after a 30-second painful stimulus. Secondary outcomes included the predictability of milnacipran efficacy from CPM performance, evolution of global pain, mechanical sensitivity, thermal pain threshold, mechanical allodynia, cognitive function, and tolerance. RESULTS: Fifty-four women with fibromyalgia (46.7±10.6 years) were included and randomized, and 24 patients were analyzed in each group. At inclusion, CPM was dysfunctional (CPM(30)=−0.5±1.9), and global pain was 6.5±1.8. After treatment, there was a nonsignificant CPM difference between milnacipran and placebo (CPM(30)=−0.46±1.22 vs −0.69±1.43, respectively, p=0.55) and 18.8% vs 6.3% (p=0.085) patients did reactivate CPM after milnacipran vs placebo. Initial CPM was not a predictor of milnacipran efficacy. Global pain, mechanical and thermal thresholds, allodynia, cognition, and tolerance were not significantly different between both groups. CONCLUSION: Milnacipran did not display a significant analgesic effect after 1-month treatment, but the tendency of milnacipran to reactivate CPM in a number of patients must be explored with longer treatment duration in future studies and pleads for possible subtypes of fibromyalgia patients. Dove Medical Press 2018-08-10 /pmc/articles/PMC6089099/ /pubmed/30127596 http://dx.doi.org/10.2147/DDDT.S162810 Text en © 2018 Pickering et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Pickering, Gisèle
Macian, Nicolas
Delage, Noémie
Picard, Pascale
Cardot, Jean-Michel
Sickout-Arondo, Sophia
Giron, Fatiha
Dualé, Christian
Pereira, Bruno
Marcaillou, Fabienne
Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study
title Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study
title_full Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study
title_fullStr Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study
title_full_unstemmed Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study
title_short Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study
title_sort milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089099/
https://www.ncbi.nlm.nih.gov/pubmed/30127596
http://dx.doi.org/10.2147/DDDT.S162810
work_keys_str_mv AT pickeringgisele milnacipranpoorlymodulatespaininpatientssufferingfromfibromyalgiaarandomizeddoubleblindcontrolledstudy
AT maciannicolas milnacipranpoorlymodulatespaininpatientssufferingfromfibromyalgiaarandomizeddoubleblindcontrolledstudy
AT delagenoemie milnacipranpoorlymodulatespaininpatientssufferingfromfibromyalgiaarandomizeddoubleblindcontrolledstudy
AT picardpascale milnacipranpoorlymodulatespaininpatientssufferingfromfibromyalgiaarandomizeddoubleblindcontrolledstudy
AT cardotjeanmichel milnacipranpoorlymodulatespaininpatientssufferingfromfibromyalgiaarandomizeddoubleblindcontrolledstudy
AT sickoutarondosophia milnacipranpoorlymodulatespaininpatientssufferingfromfibromyalgiaarandomizeddoubleblindcontrolledstudy
AT gironfatiha milnacipranpoorlymodulatespaininpatientssufferingfromfibromyalgiaarandomizeddoubleblindcontrolledstudy
AT dualechristian milnacipranpoorlymodulatespaininpatientssufferingfromfibromyalgiaarandomizeddoubleblindcontrolledstudy
AT pereirabruno milnacipranpoorlymodulatespaininpatientssufferingfromfibromyalgiaarandomizeddoubleblindcontrolledstudy
AT marcailloufabienne milnacipranpoorlymodulatespaininpatientssufferingfromfibromyalgiaarandomizeddoubleblindcontrolledstudy