Eficacia de las perfusiones de lidocaína en la fibromialgia: estudio prospectivo de cohorte

espanolRESUMEN Introduccion: La fibromialgia se define como un sindrome de dolor cronico benigno caracterizado por dolor generalizado, fatiga, alteracion del sueno, ansiedad y depresion, y en muchas ocasiones una respuesta al tratamiento insuficiente y frustrante que obliga a la comunidad medica a un esfuerzo continuo en la busqueda de un tratamiento optimo. Hemos evaluado el efecto de la lidocaina intravenosa en perfusion sobre las diferentes caracteristicas de la fibromialgia. Metodos: Despues de la aprobacion del comite de etica de nuestro hospital y el consentimiento informado de cada paciente, se incluyeron 62 pacientes con criterio de fibromialgia segun la American College of Rheumatology. Se realizaron perfusion de lidocaina a dosis creciente desde 2 mg/kg hasta 5 mg/kg durante 10 dias. En todos los casos se rellenaron los siguientes cuestionarios en el dia 0 (pretratamiento), dia 10 (postratamiento) dia 30 y dia 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) anos. Encontramos una mejoria en los cuestionarios BPI, BFI y BDI-II en el dia 10 que no se mantienen a los 30 dias. Discusion: En nuestro estudio el tratamiento con perfusiones de lidocaina en pacientes con fibromialgia objetivo una buena eficacia inicial que no se mantuvo con el paso del tiempo. EnglishABSTRACT 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.