title: Plasma levels of milnacipran and its effectiveness for the treatment of chronic pain in the orofacial region.
abstract: OBJECTIVE
  This study was performed to assess the relationship between plasma levels of milnacipran and its analgesic/antidepressive effect in patients with chronic orofacial pain treated with this drug.
  
  
  METHODS
  A total of 44 patients took milnacipran for 12 weeks. Patients were assessed for their pain and depressive symptoms using the visual analog scale (VAS) and Hamilton Depression Rating Scale, respectively. The plasma milnacipran level was also assessed at week 12.
  
  
  RESULTS
  Forty patients completed study treatment and were included in the analysis. In these patients, the VAS score at week 12 significantly decreased from the baseline score (t = 5.15, p < 0.0001). The dose of milnacipran was positively correlated in a linear manner with the plasma level of the drug (Y = 44.86 + 0.33X, r = 0.54, R(2)  = 0.29, p = 0.0004). A quadratic regression curve was plotted between the percentage of decrease in the VAS score and plasma milnacipran level (Y = 27.39 + 0.76X - 0.008X(2) , p = 0.048, r = 0.40, R(2)  = 0.16). On the other hand, no significant relationship was noted between the percentage of decrease in the Hamilton Depression Rating Scale score and plasma milnacipran level.
  
  
  CONCLUSIONS
  The analgesic effect of milnacipran was suppressed in the presence of the plasma level of the drug outside the therapeutic range, whereas its antidepressant effect was not affected by its plasma level.
authors.affiliation: Department of Psychiatry, Nagoya University Graduate School of Medicine, Japan. kimurahi@med.nagoya-u.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kimura
authors.forename: Keizo
authors.initials: K
authors.lastname: Yoshida
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ito
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Tokura
authors.forename: Wataru
authors.initials: W
authors.lastname: Nagashima
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kurita
authors.forename: Norio
authors.initials: N
authors.lastname: Ozaki
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000097:blood* / Q000627:therapeutic use*; D059350:Chronic Pain; D003521:Cyclopropanes / Q000097:blood* / Q000627:therapeutic use*; D003863:Depression / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D005157:Facial Pain / Q000097:blood / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000078764:Milnacipran; D010147:Pain Measurement; D012189:Retrospective Studies; D013223:Statistics as Topic; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D003521:Cyclopropanes; D000078764:Milnacipran