J Korean Soc Magn Reson Med.  2014 Dec;18(4):341-351. 10.13104/jksmrm.2014.18.4.341.

Comparison of the Medication Effects between Milnacipran and Pregabalin in Fibromyalgia Syndrome Using a Functional MRI: a Follow-up Study

• Kang MJ
• Mun CW
• Lee YH
• Kim SH

• KMID: 2206931
• DOI: http://doi.org/10.13104/jksmrm.2014.18.4.341

Abstract

PURPOSE
In this study, the medication effects of Milnacipran and Pregabalin, as well known as fibromyalgia treatment medicine, in fibromyalgia syndrome patients were compared through the change of BOLD signal in pain related functional MRI.
MATERIALS AND METHODS
Twenty fibromyalgia syndrome patients were enrolled in this study and they were separated into two groups according to the treatment medicine: 10 Milnacipran (MLN) treatment group and 7 Pregabalin (PGB) treatment group. For accurate diagnosis, all patients underwent several clinical tests. Pre-treated and post-treated fMRI image with block-designed pressure-pain stimulation for each group were obtained to conduct the statistical analysis of paired t-test and two sample t-test. All statistical significant level was less than 0.05.
RESULTS
In clinical tests, the clinical scores of the two groups were not significantly different at pre-treatment stage. But, PGB treatment group had lower Widespread Pain Index (WPI) and Brief Fatigue Inventory (BFI) score than those of MLN treatment group at post-treatment stage. In functional image analysis, BOLD signal of PGB treatment group was higher BOLD signal at several regions including anterior cingulate and insula than MLN treatment group at post-treatment stage. Also, paired t-test values of the BOLD signal in MLN group decreased in several regions including insula and thalamus as known as 'pain network'. In contrast, size and number of regions in which the BOLD signal decreased in PGB treatment group were smaller than those of MLN treatment group.
CONCLUSION
This study showed that MLN group and PGB group have different medication effects. It is not surprising that MLN and PGB have not the same therapeutic effects since these two drugs have different medicinal mechanisms such as antidepressants and anti-seizure medication, respectively, and different detailed target of fibromyalgia syndrome treatment. Therefore, it is difficult to say which medicine will work better in this study.

Keyword

fMRI; BOLD signal; Fibromyalgia syndrome; Milnacipran; Pregabalin

MeSH Terms

Antidepressive Agents
Diagnosis
Fatigue
Fibromyalgia*
Follow-Up Studies*
Humans
Magnetic Resonance Imaging*
Prostaglandins B
Thalamus
Pregabalin
Antidepressive Agents
Prostaglandins B

Figure

• 

  Fig. 1 Photography of laboratory developed pressure-pain stimulator.

• 

  Fig. 2 Pressure-pain stimulation paradigm of the fMRI scan.

• 

  Fig. 3 Comparison of Pregabalin treatment group (Black) and Milnacipran treatment group (Gray) at pre-treatment (left) and post-treatment (right).

• 

  Fig. 4 The regions where the activation area of MLN group is larger than that of PGB group: Cingulate gyrus (a). The regions where the activation area of PGB group is larger than that of MLN group: Superior temporal gyrus (b), Anterior cingulate (c), Insula (d).

• 

  Fig. 5 The regions where BOLD signal increased at PGB post-treatment stage: Anterior cingulate (a), Insula (b) and decreased BOLD signal region: Insula (c), Cingulate gyrus (d).

• 

  Fig. 6 The regions where the BOLD signal increased at MLN post-treatment stage: Superior frontal gyrus (a), Cingulate gyrus (b) and decreasing BOLD signal regions: Insula (c), Thalamus (d).

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