Fibromyalgia medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
As with many other syndromes, there is no universally accepted cure for fibromyalgia, though some physicians claim to have found cures.[1] However, a steady interest in the disorder on the part of academic researchers as well as pharmaceutical interests has led to improvements in its treatment, which ranges from symptomatic prescription medication to alternative and complementary medicine.
The European League Against Rheumatism (EULAR) issued the first guidelines for the treatment of fibromyalgia syndrome (FMS) and published them in the September 17th On-line First issue of the Annals of the Rheumatic Diseases.
Medications
Many medications are used to treat specific symptoms of fibromyalgia, such as muscle pain and insomnia.
Pain Relief
A number of pain relievers have been prescribed for fibromyalgia. This includes NSAID medications over the counter, COX-2 inhibitors, and tramadol in prescription form for more advanced cases. Recently, pregabalin (marketed as Lyrica) has been given FDA approval for the treatment of diagnosed Fibromyalgia.
Muscle Relaxants
Muscle relaxants, such as cyclobenzaprine (Flexeril) or tizanidine (Zanaflex), may be used to treat the muscle pain associated with the disorder.
Tricyclic antidepressants (TCAs)
Traditionally, low doses of sedating antidepressants (e.g. amitriptyline and trazodone) have been used to reduce the sleep disturbances that are associated with fibromyalgia and are believed by some practitioners to alleviate the symptoms of the disorder. Because depression often accompanies chronic illness, these antidepressants may provide additional benefits to patients suffering from depression. Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain. It is to be noted that Fibromyalgia is not considered a depressive disorder; antidepressants are used for their sedating effect to aid in sleep.
Selective serotonin reuptake inhibitors (SSRIs)
Research data consistently contradict the utility of agents with specificity as serotonin reuptake inhibitors for the treatment of core symptoms of fibromyalgia. [2][3][4] Moreover, SSRIs are known to aggravate many of the comorbidities that commonly affect patients with fibromyalgia including restless legs syndrome and sleep bruxism[5][6][7].
Anti-seizure drugs
Anti-seizure drugs are also sometimes used, such as gabapentin[8] and pregabalin (Lyrica). Pregabalin, originally used for the nerve pain suffered by diabetics, has been approved by the American Food and Drug Administration for treatment of fibromyalgia. A randomized controlled trial of pregabalin 450 mg/day found that a number needed to treat of 6 patients for one patient to have 50% reduction in pain.[9]
Dopamine agonists
Dopamine agonists (e.g. pramipexole (Mirapex) and ropinirole(ReQuip)) have been studied for use in the treatment of fibromyalgia with good results. [10] A trial of transdermal rotigotine is currently on going [11].
Combination therapy
A controlled clinical trial of amitriptyline and fluoxetine demonstrated utility when used in combination.[12]
Cannabis and cannabinoids
Fibromyalgia patients frequently self-report using cannabis therapeutically to treat symptoms of the disorder.[13] Writing in the July 2006 issue of the journal Current Medical Research and Opinion, investigators at Germany's University of Heidelberg evaluated the analgesic effects of oral THC (∆9-tetrahydrocannabinol) in nine patients with fibromyalgia over a 3-month period. Subjects in the trial were administered daily doses of 2.5 to 15 mg of THC, but received no other pain medication during the trial. Among those participants who completed the trial, all reported a significant reduction in daily recorded pain and electronically induced pain.[14] Previous clinical and preclinical trials have shown that both naturally occurring and endogenous cannabinoids hold analgesic qualities,[15] particularly in the treatment of cancer pain and neuropathic pain,[16][17] both of which are poorly treated by conventional opioids. As a result, some experts have suggested that cannabinoid agonists would be applicable for the treatment of chronic pain conditions unresponsive to opioid analgesics such as fibromyalgia, and they propose that the disorder may be associated with an underlying clinical deficiency of the endocannabinoid system.[18]
Topical Remedies
Users of Epsom Salts in the gel form (Magnesium Sulfate), have reported significant and lasting relief from pain associated with fibromyalgia. Epsom Salts have long been touted for its ability to reduce pain and swelling.
Injection Therapy
Interventional therapy can ease pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, proliferative agents (Prolotherapy) into affected soft tissues, joints, or nerve roots to more complex nerve blocks. Chronic use of steroid injections may lead to increased functional impairment.
References
- ↑ Selfridge, Dr. Nancy, and Peterson, Franklynn (2001). Freedom from Fibromyalgia: The 5-Week Program Proven to Conquer Pain. ISBN 0-8129-3375-3.
- ↑ A randomized controlled trial of citalopram in the...[Pain. 1995] - PubMed Result
- ↑ Citalopram in patients with fibromyalgia-a random...[Eur J Pain. 2000] - PubMed Result
- ↑ A randomized, controlled, trial of controlled rele...[Am J Med. 2007] - PubMed Result
- ↑ Extrapyramidal reactions and the selective seroton...[Ann Pharmacother. 1997] - PubMed Result
- ↑ Movement disorders associated with the serotonin s...[J Clin Psychiatry. 1996] - PubMed Result
- ↑ Selective serotonin-reuptake inhibitor-induced mov...[Ann Pharmacother. 1998] - PubMed Result
- ↑ Arnold LM, Goldenberg DL, Stanford SB, et. al. Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial. Arthritis Rheum. 2007 Apr;56(4):1336-44
- ↑ Crofford LJ, Rowbotham MC, Mease PJ; et al. (2005). "Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial". Arthritis Rheum. 52 (4): 1264–73. doi:10.1002/art.20983. PMID 15818684.
- ↑ Andrew J. Holman and Robin R. Myers (2005). "A Randomized, Double-Blind, Placebo-Controlled Trial of Pramipexole, a Dopamine Agonist, in Patients With Fibromyalgia Receiving Concomitant Medications". Arthritis and Rheumatism. 52 (8): 2495–2505.
- ↑ A Double-Blind Multicenter Proof of Concept Trial to Assess the Efficacy and Safety of Rotigotine in Subjects With Fibromyalgia Syndrome - Full Text View - ClinicalTrials.gov
- ↑ Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmid C (1996). "A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia". Arthritis Rheum. 39 (11): 1852–9. PMID 8912507.
- ↑ Swift W, Gates P, Dillon P (2005). "Survey of Australians using cannabis for medical purposes" (PDF). Harm reduction journal. 2: 18. doi:10.1186/1477-7517-2-18. PMID 16202145.
- ↑ Schley M, Legler A, Skopp G, Schmelz M, Konrad C, Rukwied R (2006). "Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief". Current medical research and opinion. 22 (7): 1269–76. doi:10.1185/030079906X112651. PMID 16834825.
- ↑ Burnes TL, Ineck JR. "Cannabinoid Analgesia as a Potential New Therapeutic Option in the Treatment of Chronic Pain". Annals of Pharmacotherapy. 40 (2): 251–60. doi:10.1345/aph.1G217.
- ↑ Radbruch L, Elsner F (2005). "Emerging analgesics in cancer pain management". Expert opinion on emerging drugs. 10 (1): 151–71. PMID 15757410.
- ↑ Notcutt W, Price M, Miller R; et al. (2004). "Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 'N of 1' studies". Anaesthesia. 59 (5): 440–52. doi:10.1111/j.1365-2044.2004.03674.x. PMID 15096238.
- ↑ Russo EB (2004). "Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?". Neuro Endocrinol. Lett. 25 (1–2): 31–9. PMID 15159679.