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Kang, Mun, Lee, and Kim: Comparison of the Medication Effects between Milnacipran and Pregabalin in Fibromyalgia Syndrome Using a Functional MRI: a Follow-up Study
Original Article

Journal of the Korean Society of Magnetic Resonance in Medicine 2014; 18(4): 341-351.

Published online: 31 December 2014

DOI: https://doi.org/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

Min Jae Kang1, , Chi-Woong Mun2, Young Ho Lee3, Seong-Ho Kim4,

1Department of Health Science and Technology, Inje University, Gyeongnam, Korea.

2Department of Biomedical Engineering & u-HARC, Inje Univ., Gyeongnam, Korea.

3Center for Neuroscience Imaging Research, Institute for Basic Science, Gyunggi, Korea.

4Department of Internal Medicine, Inje Univ., Heaundae Paik Hospital, Busan, Korea.

Corresponding author: Chi-Woong Mun, Ph.D. Department of Biomedical Engineering/u-HARC, Inje University, Building A, 197 Inje-ro, Gimhae-si, Gyeongnam 621-749, Korea. Tel. 82-55-320-3297, Fax. 82-55-327-3292, mcw@inje.ac.kr

Equal contributor:

1Min Jae Kang and 4Seong-Ho Kim contributed equally to this study as first authors.

Received 22 August 2014       Revised 1 October 2014       Accepted 27 October 2014

Copyright © 2014 Journal of the Korean Society of Magnetic Resonance in Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: fMRI, BOLD signal, Fibromyalgia syndrome, Milnacipran, Pregabalin

Figures and Tables

Fig. 1
Photography of laboratory developed pressure-pain stimulator.
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Fig. 2
Pressure-pain stimulation paradigm of the fMRI scan.
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Fig. 3
Comparison of Pregabalin treatment group (Black) and Milnacipran treatment group (Gray) at pre-treatment (left) and post-treatment (right).
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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).
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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).
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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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Table 1
The Statistical Results of Subject's Clinical data (mean±SD)
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Table 2
Activation Region of MLN Treatment Group is Larger than PGB Treatment Group (p<0.005, Uncorrected for Multiple Comparison)
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Table 3
Activation Region of PGB Treatment Group Larger than MLN Treatment Group (p<0.005, Uncorrected for Multiple Comparison)
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Table 4
Activation Region Increasing BOLD Signal at PGB Post-Treatment (p<0.05, Corrected for Multiple Comparison)
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Table 5
Activation Region Decreasing BOLD Signal at PGB Post-treatment (p<0.05, Corrected for Multiple Comparison)
jksmrm-18-341-i005
Table 6
Activation Region of MLN Post-treatment Group Larger than That of MLN Pre-treatment Group (p<0.05, Corrected for Multiple Comparison)
jksmrm-18-341-i006
Table 7
Activation Region of MLN Post-treatment Group is Smaller than That of MLN Pre-treatment Group (p<0.05, Corrected for Multiple Comparison)
jksmrm-18-341-i007

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