Öz
Aim. We aimed to search the effectiveness of gabapentin in the treatment of female fibromyalgia patients. Methods. Seventy-five female fibromyalgia patients were included in the study. The patients were randomly assigned to three groups. First group was given gabapentin (1200-2400 mg/day); second group was given amytriptyline (25 mg/day) and the third group was given placebo. Patients were evaluated before and after the 12th week of the treatment by the same doctor. Number of the tender points were counted, VAS for pain, fatigue and morning stiffness were evaluated, and Beck Depression Scale (BDS), Pittsburgh Sleep Quality Index (PSQI) and Fibromyalgia Impact Questionnaire (FIQ) were given to the patients. Results. Considering the
results at the 12th week, the improvement in fatigue, morning stiffness, tender point count, PSQI and FIQ were statistically significant in all of the groups (p<0.05). There was improvement in BDS in amytriptyline group (p<0.05), and pain in gabapetin and placebo groups (p<0.05). On comparing the groups, there was a difference in fatigue on behalf of gabapentin (p<0,05) and there was a significant difference between amytriptyline and placebo in PSQI values (p<0,05). Other parameters were comparable in all of the groups. Conclusions. Gabapentin and amytriptyline were found to be favourable regarding fatigue and pain, and depression and PSQI, respectively. Unfortunately, although there were statistically significant improvements after the treatment the overall impacts were not satisfactory. Gabapentin was found to be as effective as amytriptyline, which is still the gold standart treatment of FMS, however this effect was not different from that of placebo. Our study revealed that the effect of amytriptyline in fibromyalgia is questionable and gabapentin seems far away from meeting the needs for giving up searching new treatment modalities in FMS.
Anahtar Kelimeler
Kaynakça
- Çapacı K, Hepgüler S . Fibromyalji sendromu : etiyopatogenez. Ege Fiz Tıp Reh Der.1998; 4 : 219-25.
- İnanıcı F. Fibromiyalji ve Miyofasial Ağrı Sendromları. Turkiye Klinikleri J Int Med Sci 2005; 1: 11-8.
- Çapacı K, Hepgüler S. Fibromiyalji Sendromu. Ege Fiziksel Tıp ve Rehabilitasyon Dergisi 1999; 5 : 73-82.
- Sarzi-Puttini P, Buskila D, Carrabba M, Doria A, Atzeni F. Treatment strategy in fibromyalgia syndrome: where are we now? Semin Arthritis Rheum 2008; 37: 353-65.
- Perrot S, Dickenson AH, Bennett RM. Fibromyalgia: harmonizing science with clinical practice considerations. Pain Pract 2008; 8: 177-89.
- Arnold LM, Goldenberg DL, Stanford SB, Lalonde JK, Sandhu HS, Keck PE Jr, Welge JA, Bishop F, Stanford KE, Hess EV, Hudson JI Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial. Arthritis Rheum 2007; 56: 1336-44.
- Pande AC, Davidson JR, Jefferson JW, Janney CA, Katzelnick DJ, Weisler RH, Greist JH, Sutherland SM Treatment of social phobia with gabapentin: a placebo-controlled study. J Clin Psychopharmacol 1999; 19: 341-8.
- Taylor CP, Gee NS, Su TZ, Kocsis JD, Welty DF, Brown JP, Dooley DJ, Boden P, Singh L. A summary of mechanistic hypotheses of gabapentin pharmacology. Epilepsy Res 1998; 29: 233-49.
- Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum 1990; 33: 160-72.
- Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int 2000; 20: 9-12.
- Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol 2005; 23: 154-62.
- Kapci EG, Uslu R, Turkcapar H, Karaoglan A. Beck Depression Inventory II: evaluation of the psychometric properties and cut-off points in a Turkish adult population. Depress Anxiety 2008; 25: E104-10.
- Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
- Ağargün MY, Kara H, Anlar O. Pittsburgh uyku kalitesi indeksinin geçerliği ve güvenirliği. Türk Psikiyatri Dergisi 1996; 7: 107-15.
- Arnold LM, Keck PE Jr, Welge JA. Antidepressant treatment of fibromyalgia: a meta- analysis and review. Psychosomatics 2000; 41: 104|-13.
- Kempenaers C, Simenon G, Vander Elst M, Fransolet L, Mingard P, de Maertelaer V, Appelboom T, Mendlewicz J. Effect of an antidiencephalon immune serum on pain and sleep in primary fibromyalgia. Neuropsychobiology 1994; 30: 66-72.
- Thomas E, Blotman F. Are antidepressants effective in fibromyalgia? Joint Bone Spine 2002; 69: 531-3.
- Carette S, Bell MJ, Reynolds WJ, Haraoui B, McCain GA, Bykerk VP, Edworthy SM, Baron M, Koehler BE, Fam AG. Comparison of amitriptiline, cyclobenzaprine and placebo in the treatment of fibromyalgia. Arthritis Rheum 1994; 37: 32-40.
- Johnson SP. Fluoxetine and amitriptyline in the treatment of fibromyalgia. J Fam Pract 1997; 44: 128-30.
- Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmid C. A randomized, double- blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum 1996; 39: 1852-9.
- Woolf CJ. Pain: Moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 2004; 140: 441-51.
- Urban MO, Ren K, Park KT, Campbell B, Anker N, Stearns B, Aiyar J, Belley M, Cohen C, Bristow L. Comparison of the antinociceptive profiles of gabapentin and 3- methylgabapentin in rat models of acute and persistent pain. J Pharmacol Exp 2005; 313: 1209-16.
- Gore M, Pharm B, Sadosky AB, Zlateva G, Clauw DJ. Clinical characteristics, pharmacotherapy and healthcare resource use among patients with fibromyalgia newly prescribed gabapentin or pregabalin. Pain Practice 2009; 9: 363-74.
- Crofford LJ, Rowbotham MC, Mease PJ, Russell IJ, Dworkin RH, Corbin AE, Young JP Jr, LaMoreaux LK, Martin SA, Sharma U; Pregabalin 1008-105 Study Group Pregabalin for the treatment of fibromyalgia syndrome. Arthritis Rheum 2005; 52: 1264-73.
Öz
Amaç. Biz bu çalışmada fibromiyaljili kadın olguların tedavisinde gabapentinin etkinliğini araştırdık. Yöntem. Fibromiyalji tanısı alan 75 kadın hasta çalışmaya alındı. Hastalar rastgele üç gruba bölündü. Birinci gruba 1200-2400 mg/gün arasında gabapentin; ikinci gruba 25 mg/gün amitriptilin; üçüncü gruba ise plasebo tedavisi uygulandı. Hastalar tedaviden önce ve tedavinin onikinci haftasında aynı hekim tarafından değerlendirildiler. Hassas nokta sayısı saptandı, ağrı, yorgunluk ve sabah tutukluğu için VAS, Beck Depresyon Ölçeği (BDÖ), Pittsburgh Uyku Kalite İndeksi (PUKİ), ve Fibromiyalji Etki Sorgulaması Formu (FIQ) uygulandı. Bulgular. Onikinci haftadaki değerlere bakıldığında her üç grupta da yorgunluk, sabah tutukluğu, hassas nokta sayısı,
PUKİ ve FIQ değerlerindeki düzelmeler istatistiksel olarak anlamlı bulundu (p<0,05). Ayrıca amitriptilin grubunda BDÖ, gabapentin ve plasebo gruplarında ağrı değerlerinde anlamlı düzelmeler vardı (p<0,05). Grupların birbirleriyle karşılaştırılmalarında ise gabapentin grubunda yorgunluk değerlerindeki düzelme diğer iki gruptan daha üstün bulundu (p<0,05). PUKİ değerlerindeki düzelme amitriptilin grubunda plasebodan daha üstündü (p<0,05). Diğer parametrelerde gruplar arasında anlamlı farklılık yoktu. Sonuçlar. Çalışmamızda gabapentin yorgunluk ve ağrı, amitriptilin ise depresyon ve uyku kalitesi açısından daha etkili bulunmuştur. Ancak tedavi sonrası izlem parametrelerindeki değişiklikler her ne kadar istatistiksel olarak anlamlı görünse de, sağlanan iyileşme tatmin edici olmaktan çok uzaktır. Gabapentin halen fibromiyalji tedavisinde altın standart olarak kabul edilen amitriptilin kadar etkili görünmektedir ama bu etkinlik plasebonunkinden farklı değildir. Çalışmamıza dayanarak fibromiyalji tedavisinde amitriptilinin yerini sorgulamakta ve gabapentinin yeni tedavi seçeneklerine olan ihtiyacı azaltmadığını düşünmekteyiz.
Anahtar Kelimeler
Kaynakça
- Çapacı K, Hepgüler S . Fibromyalji sendromu : etiyopatogenez. Ege Fiz Tıp Reh Der.1998; 4 : 219-25.
- İnanıcı F. Fibromiyalji ve Miyofasial Ağrı Sendromları. Turkiye Klinikleri J Int Med Sci 2005; 1: 11-8.
- Çapacı K, Hepgüler S. Fibromiyalji Sendromu. Ege Fiziksel Tıp ve Rehabilitasyon Dergisi 1999; 5 : 73-82.
- Sarzi-Puttini P, Buskila D, Carrabba M, Doria A, Atzeni F. Treatment strategy in fibromyalgia syndrome: where are we now? Semin Arthritis Rheum 2008; 37: 353-65.
- Perrot S, Dickenson AH, Bennett RM. Fibromyalgia: harmonizing science with clinical practice considerations. Pain Pract 2008; 8: 177-89.
- Arnold LM, Goldenberg DL, Stanford SB, Lalonde JK, Sandhu HS, Keck PE Jr, Welge JA, Bishop F, Stanford KE, Hess EV, Hudson JI Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial. Arthritis Rheum 2007; 56: 1336-44.
- Pande AC, Davidson JR, Jefferson JW, Janney CA, Katzelnick DJ, Weisler RH, Greist JH, Sutherland SM Treatment of social phobia with gabapentin: a placebo-controlled study. J Clin Psychopharmacol 1999; 19: 341-8.
- Taylor CP, Gee NS, Su TZ, Kocsis JD, Welty DF, Brown JP, Dooley DJ, Boden P, Singh L. A summary of mechanistic hypotheses of gabapentin pharmacology. Epilepsy Res 1998; 29: 233-49.
- Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum 1990; 33: 160-72.
- Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int 2000; 20: 9-12.
- Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol 2005; 23: 154-62.
- Kapci EG, Uslu R, Turkcapar H, Karaoglan A. Beck Depression Inventory II: evaluation of the psychometric properties and cut-off points in a Turkish adult population. Depress Anxiety 2008; 25: E104-10.
- Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
- Ağargün MY, Kara H, Anlar O. Pittsburgh uyku kalitesi indeksinin geçerliği ve güvenirliği. Türk Psikiyatri Dergisi 1996; 7: 107-15.
- Arnold LM, Keck PE Jr, Welge JA. Antidepressant treatment of fibromyalgia: a meta- analysis and review. Psychosomatics 2000; 41: 104|-13.
- Kempenaers C, Simenon G, Vander Elst M, Fransolet L, Mingard P, de Maertelaer V, Appelboom T, Mendlewicz J. Effect of an antidiencephalon immune serum on pain and sleep in primary fibromyalgia. Neuropsychobiology 1994; 30: 66-72.
- Thomas E, Blotman F. Are antidepressants effective in fibromyalgia? Joint Bone Spine 2002; 69: 531-3.
- Carette S, Bell MJ, Reynolds WJ, Haraoui B, McCain GA, Bykerk VP, Edworthy SM, Baron M, Koehler BE, Fam AG. Comparison of amitriptiline, cyclobenzaprine and placebo in the treatment of fibromyalgia. Arthritis Rheum 1994; 37: 32-40.
- Johnson SP. Fluoxetine and amitriptyline in the treatment of fibromyalgia. J Fam Pract 1997; 44: 128-30.
- Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmid C. A randomized, double- blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum 1996; 39: 1852-9.
- Woolf CJ. Pain: Moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 2004; 140: 441-51.
- Urban MO, Ren K, Park KT, Campbell B, Anker N, Stearns B, Aiyar J, Belley M, Cohen C, Bristow L. Comparison of the antinociceptive profiles of gabapentin and 3- methylgabapentin in rat models of acute and persistent pain. J Pharmacol Exp 2005; 313: 1209-16.
- Gore M, Pharm B, Sadosky AB, Zlateva G, Clauw DJ. Clinical characteristics, pharmacotherapy and healthcare resource use among patients with fibromyalgia newly prescribed gabapentin or pregabalin. Pain Practice 2009; 9: 363-74.
- Crofford LJ, Rowbotham MC, Mease PJ, Russell IJ, Dworkin RH, Corbin AE, Young JP Jr, LaMoreaux LK, Martin SA, Sharma U; Pregabalin 1008-105 Study Group Pregabalin for the treatment of fibromyalgia syndrome. Arthritis Rheum 2005; 52: 1264-73.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Dahili Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 11 Mart 2010 |
| Yayımlandığı Sayı | Yıl 2010Cilt: 32 Sayı: 1 |