Abstract | BACKGROUND: Patients often present with chronic facial pain despite normal nasal endoscopy and sinus computerized tomography. Such pain has increasingly been recognized as being of neurological origin with one of the commonest underlying causes being mid-facial segmental tension-type pain (MFP) which is a version of tension headache in the face. Descending serotonergic neuronal projections are known to modulate pain and intra-platelet serotonin levels are an accepted model reflecting central intra-neuronal serotonin. OBJECTIVES: 1.To determine whether low-dose amitriptyline significantly changes whole blood serotonin compared to a surrogate placebo in patients with chronic MFP 2. To determine whether the addition of pindolol, a beta blocker with serotonin receptor blocking properties further alters blood serotonin. METHODOLOGY: RESULTS: There was a significant reduction in blood serotonin levels in the amitriptyline with pindolol group. A non-significant reduction was seen in the amitriptyline group, with no change in serotonin levels in the surrogate placebo group. A comparison of change in serotonin with change in pain frequency and intensity scores is presented. Women in the control group had significantly higher serotonin levels than men. Women with tension-type facial pain who failed to respond to treatment had significantly lower blood serotonin than women in the control group. CONCLUSION: When linked to the clinical response this study provides evidence that the serotonergic system is involved in the modulation of chronic MFP. Serotonin levels are sex-dependent and related to treatment response.
|
Authors | A M Agius, N S Jones, R Muscat |
Journal | Rhinology
(Rhinology)
Vol. 51
Issue 3
Pg. 236-42
(Sep 2013)
ISSN: 0300-0729 [Print] Netherlands |
PMID | 23943730
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
|
Chemical References |
- Adrenergic beta-Antagonists
- Antidepressive Agents, Tricyclic
- Placebos
- Amitriptyline
- Serotonin
- Pindolol
|
Topics |
- Adrenergic beta-Antagonists
(therapeutic use)
- Adult
- Amitriptyline
(therapeutic use)
- Analysis of Variance
- Antidepressive Agents, Tricyclic
(therapeutic use)
- Chronic Pain
- Drug Therapy, Combination
- Facial Pain
(blood, drug therapy, etiology)
- Female
- Humans
- Male
- Pain Measurement
- Pindolol
(therapeutic use)
- Placebos
- Serotonin
(blood)
- Statistics, Nonparametric
- Tension-Type Headache
(blood, complications, drug therapy)
- Treatment Outcome
|