Document Detail


Pharmacotherapy of fibromyalgia.
MedLine Citation:
PMID:  21719591     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Published evidence on the pathophysiology, diagnosis, and treatment of fibromyalgia is reviewed, with an emphasis on recent clinical trials of various pharmacologic agents.
SUMMARY: Fibromyalgia affects an estimated 2% of the general U.S. population, and its incidence is sevenfold higher among women. The diagnostic characteristics of fibromyalgia are chronic widespread pain, thought to arise from abnormalities of ascending pain and descending inhibitory sensory pathways, and allodynia on palpation of specific tender points. Three medications available in the United States are labeled for treatment of fibromyalgia-related symptoms: the serotonin- and norepinephrine-reuptake inhibitors duloxetine and milnacipran and the α(2)-δ ligand pregabalin. Evidence from clinical trials indicates that all three drugs can have a significant impact on fibromyalgia-related pain; duloxetine and pregabalin have been demonstrated to reduce sleep disturbances and improve quality of life (the former also has been shown to improve mood), while milnacipran can offer significant benefits in reducing fatigue. A growing body of evidence suggests that the best treatment approach may involve the use of one or more agents whose mechanisms of action are aligned with patient-specific clusters of symptoms. Several other agents have been used for fibromyalgia, with mixed results, including tricyclic antidepressants, selective serotonin-reuptake inhibitors, opioids, and gabapentin. Given the limitations of the evidence from clinical trials to date, controlled trials directly comparing different agents are needed to better delineate adverse-event risks, cost considerations, and optimal management approaches.
CONCLUSION: A broad range of drugs has been used to treat fibromyalgia. Symptoms, comorbidities, adverse effects, and patient preference are important considerations in drug selection.
Authors:
Laura M Traynor; Christopher N Thiessen; Andrew P Traynor
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists     Volume:  68     ISSN:  1535-2900     ISO Abbreviation:  Am J Health Syst Pharm     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-01     Completed Date:  2012-05-14     Revised Date:  2013-08-21    
Medline Journal Info:
Nlm Unique ID:  9503023     Medline TA:  Am J Health Syst Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1307-19     Citation Subset:  IM    
Affiliation:
School of Pharmacy, Concordia University Wisconsin, 12800 North Lake Shore Drive, Mequon, WI 53097, USA. laura.traynor@cuw.edu
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MeSH Terms
Descriptor/Qualifier:
Analgesics / therapeutic use*
Animals
Antidepressive Agents / therapeutic use*
Clinical Trials as Topic / methods
Cyclopropanes / therapeutic use
Fibromyalgia / diagnosis*,  drug therapy*,  physiopathology
Humans
Thiophenes / therapeutic use
gamma-Aminobutyric Acid / analogs & derivatives,  therapeutic use
Chemical
Reg. No./Substance:
0/Analgesics; 0/Antidepressive Agents; 0/Cyclopropanes; 0/Thiophenes; 55JG375S6M/pregabalin; 56-12-2/gamma-Aminobutyric Acid; G56VK1HF36/milnacipran; O5TNM5N07U/duloxetine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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