二甲双胍或可治疗腰部神经根病疼痛

亚利桑那大学的Magdalena Szkudlinska博士在内分泌学会年会上报告的一项回顾性病例对照研究显示，46例正在服用二甲双胍的腰部神经根病患者的疼痛评分，比94例未服二甲双胍的对照患者(含18例2型糖尿病患者)平均降低了1.85分(评分范围为0~10分)。两组受试者服用镇痛药物的数量相似，无1例患者合并外周神经病或其他糖尿病并发症。

已有研究者利用动物模型开展了机制研究。人们已发现，AMPK(腺苷单磷酸盐活化蛋白激酶)是慢性神经病性疼痛的一个潜在治疗靶点。可能的机制涉及二甲双胍对AMPK的活化作用，使得mTOR(哺乳动物雷帕霉素靶蛋白)通路被抑制，感觉神经元兴奋性下降，慢性神经病性疼痛减轻(Nat. Cell Biol. 2011;13:1016-23)。

Szkudlinska博士还补充道：“二甲双胍已被证明可有效减轻动物模型的伤害感受器敏化和疼痛感(Mol. Pain 2011 Sept. 21 [doi:10.1186/1744-8069-7-70])。鉴于上述研究结果，我们认为值得开展大规模前瞻性研究来评估二甲双胍治疗慢性神经病性疼痛的效果。”

这项回顾性研究获得了美国国立卫生研究院的支持。Szkudlinska博士声称无利益冲突。

By: BRUCE JANCIN, Clinical Endocrinology News Digital Network

HOUSTON – Metformin was associated with more modest reports of pain among patients with lumbar radiculopathy.

In a retrospective case-control study presented at the annual meeting of the Endocrine Society, 46 patients who were taking metformin and sought care for lumbar radiculopathy pain averaged a 1.85-point lower score on a 0-10 point "having pain now," scale as did 94 controls, 18 of whom had type 2 diabetes. The two groups were matched for their number of pain medications. None had peripheral neuropathy or other diabetic complications, reported Dr. Magdalena Szkudlinska of the University of Arizona, Tucson.

Mechanistic studies were conducted in animal models. Other researchers have identified AMPK (adenosine monophosphate–activated protein kinase) as a potential therapeutic target in chronic neuropathic pain conditions. The proposed mechanism involves activation of AMPK by metformin, with resultant inhibition of the mTOR (mammalian target of rapamycin) pathway leading to reduced sensory neuron excitability and decreased chronic neuropathic pain (Nat. Cell Biol. 2011;13:1016-23).

Moreover, Dr. Szkudlinska added, metformin has proved "remarkably effective" in reducing nociceptor sensitization and pain in animal models (Mol. Pain 2011 Sept. 21 [doi:10.1186/1744-8069-7-70]).

"We propose that these results, combined with the preclinical rationale, warrant a larger prospective study testing the effectiveness of metformin on chronic neuropathic pain," she declared.

Her retrospective lumbar radiculopathy study was supported by the National Institutes of Health. She declared having no financial conflicts.