title: Differential pharmacotherapy for subgroups of fibromyalgia patients with specific consideration of 5-HT3 receptor antagonists.
abstract: BACKGROUND
  The fibromyalgia syndrome (FMS) has a prevalence of about 2% and is characterized by generalized musculoskeletal pain, reduced pain threshold and autonomic and functional symptoms. It is a multifactorial syndrome with four different subgroups exhibiting pathophysiological and psychiatric findings. No precise treatment strategy is currently available for the different FMS subgroups.
  
  
  METHODS
  This article reviews the evidence for treatment options for the different FMS subgroups.
  
  
  CONCLUSIONS
  Therapy for the first subgroup of primary FMS, with high levels of pain but no psychopathological alterations, is targeted at nociceptors expressing serotonin (5-hydroxytryptamine-3; 5-HT3) receptors with 5-HT3 receptor antagonists. The second and third subgroups are characterized by depressive syndromes with a major indication for antidepressants. The fourth subgroup with psychosomatic syndromes requires psychotherapeutic treatment. Secondary FMS is similar to the primary syndromes but is triggered by a variety of other diseases and frequently responds to 5-HT3 receptor antagonist treatment. Different classes of drug, such as pregabalin, must be tested for efficacy and tolerance. FMS treatment strategies should be tailored after the identification of individual FMS subgroups. Although several groups of drug have been studied extensively, 5-HT3 receptor antagonists are most effective in patients without psychopathological alterations.
authors.affiliation: Medizinische Klinik und Poliklinik I, Rheumatology Unit, Wilhelmstrasse, Bonn, Germany. Matthias.Seidel@ukb.uni-bonn.de
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Seidel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Müller
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D005356:Fibromyalgia / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D011613:Psychotherapy / Q000379:methods; D044406:Receptors, Serotonin, 5-HT3 / Q000378:metabolism; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000627:therapeutic use*
chemical_list: D000928:Antidepressive Agents; D044406:Receptors, Serotonin, 5-HT3; D058831:Serotonin 5-HT3 Receptor Antagonists