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Заключение Имеющиеся в литературе данные подтверждают эффективность дулоксетина при БСС в рамках БДР, ДПНБ и ФМС. Наличие этого эффекта при хронических болях соотносится со сбалансированным спектром рецепторного воздействия дулоксетина, направленного как на серотонин-, так и на норадренергическую систему. Несмотря на то что определенный обезболивающий эффект может быть частично отнесен на счет опосредованного антидепрессивного эффекта дулоксетина, более значимая его часть целиком определяется непосредственным специфическим аналгезирующим действием, что подтверждается в ряде исследований. С помощью современных статистических методов (анализ пути) показано, что редукция БСС при большой депрессии, ДПНБ и ФМС при применении дулоксетина осуществляется за счет непосредственного обезболивающего эффекта, на долю которого приходятся 50, 90 и 80% соответственно. Во всех трех проведенных исследованиях эффективности дулоксетина при ДПНБ продемонстрирован выраженный аналгезирующий эффект препарата, хотя пациентов с депрессией в эти исследования не включали. Преимущество дулоксетина перед плацебо при ФМС четко прослеживается как у депрессивных пациентов, так и у больных без признаков депрессии. Эффективность дулоксетина при БСС в рамках БДР подтверждается отсутствием статистически достоверных отличий препарата от плацебо при общих депрессивных симптомах (оцененных по HAMD) в единственном исследовании. Имеются основания утверждать, что дулоксетин оказывает непосредственный обезболивающий эффект у больных с БДР ДПНБ и ФМС. Такой эффект основан на сбалансированном одновременном воздействии на серотонин- и норадренергическую системы, является независимым и дополняет антидепрессивные свойства дулоксетина.
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