Venlafaxine treatment of fibromyalgia.
BACKGROUND
Although the pathophysiology of fibromyalgia is unknown, central monoaminergic transmission may play a role. Antidepressants have proved to be successful in alleviating symptoms of fibromyalgia. Medications that act on multiple neurotransmitters may be more effective in symptom management.


OBJECTIVE
To assess the efficacy of venlafaxine, a potent inhibitor of both norepinephrine and serotonin reuptake, in the treatment of patients with fibromyalgia.


METHODS
Fifteen patients with fibromyalgia were assessed prior to and after treatment with fixed-dose venlafaxine 75 mg/d. Before initiation of pharmacotherapy, patients were interviewed with the Structured Clinical Interview for Axis I disorders in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The study lasted for 12 weeks, and patients were evaluated in weeks 6 and 12. The primary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ) total score and pain score. The anxiety and depression levels of the patients were measured with the Beck Depression, the Beck Anxiety, the Hamilton Anxiety, and the Hamilton Depression scales.


RESULTS
There was a significant improvement in the mean intensity of pain (F = 14.3; p = 0.0001) and in the disability caused by fibromyalgia (F = 42.7; p = 0.0001) from baseline to week 12 of treatment. The depression and anxiety scores also decreased significantly from baseline to week 12. The improvement in the FIQ scores did not correlate with the decrease of scores in both patient- and physician-rated depression and anxiety inventories. Change in pain scores also was not correlated with the change in depression and anxiety scores.


CONCLUSIONS
Venlafaxine was quite promising in alleviating the pain and disability associated with fibromyalgia. This effect seems to be independent of its anxiolytic and antidepressant properties. Blockade of both norepinephrine and serotonin reuptake might be more effective than blockade of either neurotransmitter alone in the treatment of fibromyalgia.
Sayar
Kemal
K
Karadeniz Technical University School of Medicine, Farabi Hospital, Trabzon, Turkey. mkemalsayar@superonline.com
Aksu
Gokhan
G
Ak
Ismail
I
Tosun
Mehmet
M
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000328:Adult; D001007:Anxiety / Q000150:complications / Q000188:drug therapy; D003511:Cyclohexanols / Q000627:therapeutic use*; D003863:Depression / Q000150:complications / Q000188:drug therapy; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D000069470:Venlafaxine Hydrochloride
D018759:Adrenergic Uptake Inhibitors; D003511:Cyclohexanols; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride