Pain management in fibromyalgia.
1University of Kentucky, Lexington, Kentucky 40536, USA. lcrofford@uky.edu
Current Opinion in Rheumatology
|April 5, 2008
Summary
Newer medications targeting central pain mechanisms offer improved pain relief for fibromyalgia patients. These therapies, including alpha-2-delta ligands and serotonin-norepinephrine reuptake inhibitors, are effective for chronic pain management in rheumatic diseases.
Area of Science:
- Rheumatology
- Pain Medicine
- Neuroscience
Background:
- Pain is a primary symptom in most rheumatic diseases, often inadequately managed by traditional treatments.
- Fibromyalgia and other chronic pain syndromes frequently show incomplete response to standard analgesics.
- Effective pain management necessitates exploring additional therapeutic strategies.
Purpose of the Study:
- To review novel treatment strategies for fibromyalgia pain.
- To explore the applicability of these strategies to other rheumatic diseases.
- To highlight medications targeting central pain mechanisms.
Main Methods:
- Review of recent clinical studies and literature on pain management in fibromyalgia.
- Focus on medications targeting neurobiological pain pathways.
- Analysis of drug classes including alpha-2-delta ligands and SNRIs.
Main Results:
- Alpha-2-delta ligands (gabapentin, pregabalin) show effectiveness in fibromyalgia.
- Serotonin-norepinephrine reuptake inhibitors (duloxetine, milnacipran) are effective for fibromyalgia.
- These medications target pain neurobiology in the spinal cord and brain.
Conclusions:
- New therapies targeting central pain mechanisms can benefit patients with fibromyalgia.
- These novel treatments may also be useful for chronic pain associated with other rheumatic disorders.
- Improved pain relief is achievable through understanding and targeting central pain pathways.
Related Concept Videos
01:25Analgesia and Pain Management
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
01:09Peripherally and Centrally Acting Muscle Relaxants: A Comparison
Skeletal muscle relaxants can target the central nervous system [CNS] to reduce muscle tension or act directly at the neuromuscular junction to induce temporary paralysis. These two classes of muscle relaxants are called centrally acting muscle relaxants and peripherally acting muscle relaxants. They differ in their action, mechanism, administration route, and clinical uses.
Centrally acting muscle relaxants can be further divided into spasmolytic and antispasmodic drugs. Spasmolytic drugs,...
Centrally acting muscle relaxants can be further divided into spasmolytic and antispasmodic drugs. Spasmolytic drugs,...
01:24Centrally Acting Muscle Relaxants: Therapeutic Uses
Centrally acting muscle relaxants reduce muscle tone and tension by interfering with the postsynaptic reflexes in the central nervous system.
Centrally acting drugs are classified into spasmolytic and antispasmodic drugs. Spasmolytic drugs such as baclofen, diazepam, and tizanidine inhibit spinal motor neurons and decrease muscle tone. Spasmolytic drugs are administered for severe and chronic spasms due to multiple sclerosis, cerebral palsy, stroke, and spinal cord and muscle injuries. However,...
Centrally acting drugs are classified into spasmolytic and antispasmodic drugs. Spasmolytic drugs such as baclofen, diazepam, and tizanidine inhibit spinal motor neurons and decrease muscle tone. Spasmolytic drugs are administered for severe and chronic spasms due to multiple sclerosis, cerebral palsy, stroke, and spinal cord and muscle injuries. However,...
01:31Skeletal Muscle Relaxants: Therapeutic Uses
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...