多模式快速抗抑郁对躯体形式障碍性疼痛的疗效观察： 一项多中心、回顾性研究*

Observation on therapeutic effect of multimodal rapid antidepression for somatoform pain disorder：a multicenter, retrospective study

摘要:

目的:回顾性分析多模式快速抗抑郁（multimodal rapid antidepression，MRAD）对难治性抑郁伴躯体形式障碍性疼痛的疗效。方法:收集61例2023年8月至2025年2月就诊于山东第二医科大学附属医院、南方医科大学中西医结合医院及东莞市黄江医院快速抗抑郁中心，接受MRAD治疗的伴有躯体形式障碍性疼痛的难治性抑郁症患者，采用疼痛数字分级评分法 (numerical rating scale, NRS) 评分、蒙哥马利抑郁评定量表（Montgomery-Asberg Depression Rating Scale，MADRS）、汉密尔顿焦虑评分（Hamilton Anxiety Scale，HAMA）、匹兹堡睡眠质量指数问卷（Pittsburgh sleep quality index，PSQI）评估病人治疗前、治疗后24小时、1个周、1个月的疼痛程度、抑郁焦虑及睡眠情况。结果:躯体形式障碍性疼痛在难治性抑郁患者中发病率为40%，治疗后患者的疼痛NRS、MADRS、HAMA和PSQI评分均显著降低（P＜0.01）；Logistic 回归分析表明，病程 (OR = 0.907, 95% CI: 0.826-0.996, P = 0.041) 、基线MADRS评分(OR = 0.814, 95% CI: 0.708-0.935, P = 0.004)是影响快速抗抑郁对躯体形式障碍性疼痛的独立危险因素。结论:MRAD是治疗难治性抑郁伴躯体形式障碍性疼痛安全且有效的方法，病程和治疗前MADRS评分是影响治疗效果的独立危险因素。

Abstract:

Objective: To retrospectively analyze the efficacy of multimodal rapid antidepression (MRAD) in treating treatment-resistant depression with somatoform pain disorder. Methods: Sixty-one patients with treatment-resistant depression and somatoform pain disorder who received MRAD treatment at the Rapid Antidepressant Center of Shandong Second Medical University Affiliated Hospital, Southern Medical University Hospital of TCM-Integrated , and Dongguan Huangjiang Hospital between August 2023 and February 2025 were enrolled. Pain was assessed using the Numerical Rating Scale (NRS), Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Scale (HAMA), and Pittsburgh Sleep Quality Index (PSQI) to assess pain levels, depression/anxiety, and sleep quality before treatment, 24 hours post-treatment, 1 week post-treatment, and 1 month post-treatment. Results: The prevalence of somatoform pain disorder in patients with treatment-resistant depression was 40%. Following treatment, patients" pain NRS, MADRS, HAMA, and PSQI scores all decreased significantly (P < 0.01). Logistic regression analysis indicated that disease duration (OR = 0.907, 95% CI: 0.826–0.996, P = 0.041) and and baseline MADRS score (OR = 0.814, 95% CI: 0.708–0.935, P = 0.004) were independent risk factors influencing the effect of rapid antidepressant response on somatoform pain disorder. Conclusion: MRAD is a safe and effective treatment for treatment-resistant depression with somatoform pain disorder. Disease duration and pre-treatment MADRS scores are independent risk factors influencing treatment efficacy.