Rev. Soc. Esp. Dolor. 2020; 27(5): 287-291 / DOI: 10.20986/resed.2020.3796/2020
Mateo Verd, Hermann Ribera, Cristina Sansaloni, María José de Vicente, María Magdalena Truyols
RESUMEN
Introducción: La fibromialgia se define como un síndrome de dolor crónico benigno caracterizado por dolor generalizado, fatiga, alteración del sueño, ansiedad y depresión, y en muchas ocasiones una respuesta al tratamiento insuficiente y frustrante que obliga a la comunidad médica a un esfuerzo continuo en la búsqueda de un tratamiento óptimo. Hemos evaluado el efecto de la lidocaína intravenosa en perfusión sobre las diferentes características de la fibromialgia.
Métodos: Después de la aprobación del comité de ética de nuestro hospital y el consentimiento informado de cada paciente, se incluyeron 62 pacientes con criterio de fibromialgia según la American College of Rheumatology. Se realizaron perfusión de lidocaína a dosis creciente desde 2 mg/kg hasta 5 mg/kg durante 10 días. En todos los casos se rellenaron los siguientes cuestionarios en el día 0 (pretratamiento), día 10 (postratamiento) día 30 y día 90: Health Survey SF-12 (SF-12), Fibromyalgia Impact Questionnaire (FIQ), Brief Pain Inventory (BPI), Big Five Inventory (BFI), Beck Depression Inventory II (BDI-II), Medical Outcomes Sleep Scale (MOS), Patient Improvement Expectations (EXPEC).
Resultados: De los 62 pacientes, 9 abandonaron el estudio por efectos adversos intolerables y 5 se perdieron o no completaron los cuestionarios en los siguientes meses. Finalmente completaron el estudio 48 pacientes, 46 mujeres y 2 hombres con una edad media de 55 (36-70) años. Encontramos una mejoría en los cuestionarios BPI, BFI y BDI-II en el día 10 que no se mantienen a los 30 días.
Discusión: En nuestro estudio el tratamiento con perfusiones de lidocaína en pacientes con fibromialgia objetivó una buena eficacia inicial que no se mantuvo con el paso del tiempo.
ABSTRACT
Introduction: Fibromyalgia is defined as a pain syndrome characterized by generalized chronic pain, fatigue, sleep disturbances, anxiety and depression and, at times, an insufficient and frustrating treatment response. It is a benign condition chronically suffered by many patients, which forces the medical community on an ongoing search for an optimal treatment. We evaluated the effect of intravenous lidocaine on the different characteristics of fibromyalgia.
Method: This is a prospective, longitudinal study. We recorded data for 48 patients diagnosed with fibromyalgia syndrome according with the American College of Rheumatology criteria (ACR 1990). Patients with abnormal electrocardiogram or abnormal blood electrolytes were excluded. Included cases received an increasing dose of 2 mg/kg up until 5 mg/kg of an intravenous lidocaine perfusion during 10 days. All included cases filled the following questionnaires at day 0 (pre-treatment), day 10 (post-treatment) day 30 and day 90: Health Survey SF-12 (SF-12), Fibromyalgia Impact Questionnaire (FIQ), Brief Pain Inventory (BPI), Big Five Inventory (BFI), Beck Depression Inventory II (BDI-II), Medical Outcomes Sleep Scale (MOS), Patient Improvement Expectations (EXPEC).
Results: 48 cases were recorded, 46 were female and 2 were male, the median age was 55 (36-70). We found improvement in pain, fatigue and psychological attitude at 10 days that disappears at 30 days.
Discussion: The treatment with infusion of intravenous lidocaine at these doses on this set of patients did not modify the clinical characteristics of fibromyalgia as a sustained manner.
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
1. Arnold LM, Capelleri JC, Clair A, Masters ET. Interpreting effect sizes and clinical relevance of pharmacological interventions for fibromyalgia. Pain Therm. 2013;2(1):65-71. DOI: 10.1007/s40122-013-0011-1.
2. Gilbert CR, Hanson IR, Brown AB, Hingson RA. Intravenous use of xylocaine. Curr Res Anesth Analg. 1951;30(6):301-13.
3. Bartlett EE, hutserani O. Xylocaine for the relief of postoperative pain: Anesth Analg 1961;40:296-304.
4. Challapalli V, Tremont-Lukats IW, McNicol ED, Lau J, Carr DB. Systemic administration of local anesthetic agents to relieve neuropathic pain. Cochrane Database Syst Rev. 2005;(4):CD003345. DOI: 10.1002/14651858.CD003345.pub2.
5. Galer BS, Miller KV, Rowbotham MC. Response to intravenous lidocaine infusion differs based on clinical diagnosis and site of nervous system injury. Neurology. 1993;43(6):1233-5. DOI: 10.1212/wnl.43.6.1233.
6. Sörensen J, Bengstsson A, Bäckmann E, Henriksson KG, Bengtsson M, et al. Pain analysis in patients with fibromyalgia. Effects of intravenous morphine, lidocaine, and ketamine. Scand J Rheumatol. 1995;24(6):360-5. DOI: 10.3109/03009749509095181.
7. Marks D, Newhouse A. Durability of benefit from repeated inravenous lidocaine infusions in fibromyalgia patients: a case series and literature review. Prim Care Companion CNS Disord. 2015;17(5):10.4088/PCC.15br011804. DOI: 10.4088/PCC.15br01804.
8. Lirk P, Hollmann MW, Strichartz G. The science of local anesthesia: basic research, clinical application, and future directions. Anesth Analg. 2018;126(4):1381-92. DOI: 10.1213/ANE.0000000000002665.
9. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600-10. DOI: 10.1002/acr.20140
10. Vlainich R, Issy AM, Gerola LR, Sakata RK. Effect of intravenous lidocaine on manifestations of fibromyalgia. Pain Practice 2010:10(4):301-5. DOI: 10.1111/j.1533-2500.2010.00362.x.
11. Kleinman N, Harnett J, Melkonin A, Lynch W, Kaplan-Machlis B, Silverman SL. Burden of fibromyalgia and comparisons with osteoarthritis in the workforce. J Occup Environ Med. 2009:51(12):1384-93. DOI: 10.1097/JOM.0b013e3181bb808b.
12. Perrot S, Dickenson AH, Bennett RM. Fibromyalgia: harmonizing science with clinical practice considerations. Pain Pract. 2008:8(3):177-89. DOI: 10.1111/j.1533-2500.2008.00190.x.
13. Koppert W, Ostermeier N, Sittl R, Weidner C, Schmelz M. Low-dose lidocaine reduces secondary hyperlalgesia by a central mode of action. Pain. 2000;85(1-2):217-24. DOI: 10.1016/s0304-3959(99)00268-7.
14. Wu CL, Tella P, Staats PS, Vaslav R, Kazim DA, Wesselmann U, et al. Analgesia effects of intravenous lidocaine and morphine on postamputation pain: a randomized double-blind, active placebo-controlled, cross-over trial. Anesthesiology. 2002;96(4):841-8. DOI: 10.1097/00000542-200204000-00010.
15. Wildermann I, Pugacheva O, Perelman V, Wansbrough M, Voznyak Y, Zolnierczyk L. Repeated Intravenous lidocaine infusions for patients with fibromyalgia: higher doses of lidocaine have a stronger and longer-lasting effect on pain reduction. Pain Medicine. 2019:21(6):1230-9. DOI: 10.1093/pm/pnz251.
16. Bennett MI, Tai Ym. Inravenous lignocaine in the management of primary fibromyalgia syndrome. Int J Clin Pharmacol Res. 1995;15(3):115-9.
17. Marks Ad, Newhouse A. Durability of benefit from repeated intravenous lidocaine infusions in fibromyalgia patients: a case series and literature review. Prim Care Companion CNS Disrod. 2015;17(5):10.4088/PCC.15br01804. DOI: 10.4088/PCC.15br001804.
18. Raphael JH, Southall JL, Treharne GL, Kitas GD. Efficacy and adverse effects of intravenous lignocaine therapy in fibromyalgia syndrome. BMC Musculoskelet Disord. 2002;3(1):21. DOI: 10.1186/1471-2474-3-21.
19. Schafranski MD, Malucelli T, Machado F, Takeshi H, Kaiber F, Schmidt C, et al. Intravenous lidocaine for fibromialgia syndrome. An open trial. Clin Rheumatol. 2009;28(7):853-5. DOI: 10.1007/s10067-009-1137-8.
20. Sörensen J, Bengstsson A, Bäckman E, Henriksson KG, Bengtsson M. Pain analysis in patients with fibromyalgia. Effects of intravenous morphine, lidocaine, and ketamine. Scand J Rheumatol. 1995;24(6):360-5. DOI: 10.3109/03009749509095181.
21. McCleane G. Does intravenous lidocaine reduce fibromyalgia pain? A randomized double-blind, placebo-controlled cross-over study. Pain Clinic. 2000;12(3):181-5. DOI: 10.1163/156856900750232515.
22. Przeklasa-Muszynska A, kocot-Kepska M, Dobrogowski MW, Mika J. Intravenous lidocaine infusions in a multidirectional model of treatment of neuropathic pain patients. Pharmacol Rep. 2016;68(5):1069-75. DOI: 10.1016/j.pharep.2016.06.010.
23. Tremon-Lukats IW, Hutson PR, Backonja MM. A randomized, double-masked, placebo-controlled pilot trial of extended lidocaine infusion for relief of ongoing neuropathic pain. Clin J Pain. 2006;22(3):266-71. DOI: 10.1097/01.ajp.0000169673.57062.40.