Pharmacological treatment of fibromyalgia syndrome: new developments.
Fibromyalgia is a chronic pain disorder characterized by widespread pain, stiffness, insomnia, fatigue and distress. Several randomized controlled trials (RCTs) have shown moderate effectiveness of pharmacological therapies for fibromyalgia pain. Evidence from these trials suggests that pharmacological therapy can not only improve pain but also fatigue, function and well-being in patients with fibromyalgia. Duloxetine and milnacipran, two highly selective serotonin-norepinephrine (noradrenaline) reuptake inhibitors, and the alpha(2)delta agonist pregabalin have been approved by the US FDA for the treatment of fibromyalgia symptoms. In general, about half of all treated patients seem to experience a 30% reduction of symptoms, suggesting that many patients with fibromyalgia will require additional therapies. Thus, other forms of treatment, including exercise, cognitive behavioural therapies and self-management strategies, may be necessary to achieve satisfactory treatment outcomes. Despite promising results of pilot trials, RCTs with dopamine receptor agonists and sodium channel antagonists have so far been disappointing for patients with fibromyalgia. However, new pharmacological approaches for the treatment of fibromyalgia pain and insomnia using sodium oxybate appear to be promising.
Staud
Roland
R
Department of Medicine, University of Florida, College of Medicine, Gainesville, Florida 32610-0221, USA. staudr@ufl.edu
D000367:Age Factors; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D018491:Dopamine Agonists / Q000627:therapeutic use*; D000068736:Duloxetine Hydrochloride; D015444:Exercise; D005081:Exercise Therapy; D005221:Fatigue / Q000188:drug therapy / Q000209:etiology; D005356:Fibromyalgia / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects; D000069583:Pregabalin; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012648:Self Care; D013876:Thiophenes / Q000627:therapeutic use; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000627:therapeutic use
D000701:Analgesics, Opioid; D002121:Calcium Channel Blockers; D018491:Dopamine Agonists; D013876:Thiophenes; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000068736:Duloxetine Hydrochloride