Pharmacotherapy for patients with fibromyalgia
1Division of Rheumatology, Department of Internal Medicine, and Michigan Institute for Clinical and Health Research, University of Michigan Medical School, Ann Arbor, USA. dclauw@umich.edu
The Journal of Clinical Psychiatry
|June 27, 2008
Summary
Effective fibromyalgia treatment requires evidence-based pharmacotherapy and integrated non-medicinal approaches. Many commonly used medications lack efficacy for central fibromyalgic pain, highlighting the need for informed treatment selection.
Area of Science:
- Pharmacology
- Rheumatology
- Pain Management
Background:
- Fibromyalgia is a prevalent and debilitating condition characterized by widespread pain.
- Current pharmacotherapy for fibromyalgia includes tricyclic antidepressants, serotonin-norepinephrine re-uptake inhibitors, and alpha(2)delta ligands.
- Despite established treatments, ineffective medications are frequently prescribed for fibromyalgic pain.
Purpose of the Study:
- To review pharmacotherapeutic options for fibromyalgia.
- To categorize treatments based on evidence of efficacy.
- To emphasize integrated care including non-pharmacological interventions.
Main Methods:
- Literature review of pharmacologic treatments for fibromyalgia.
- Assessment of evidence levels for medication efficacy.
- Discussion of integrated treatment strategies.
Main Results:
- High-level evidence supports certain antidepressants and alpha(2)delta ligands.
- Moderate evidence exists for other agents.
- Many commonly used drugs show little to no efficacy for central pain.
Conclusions:
- Pharmacotherapy selection should be guided by evidence of efficacy.
- An integrated approach combining pharmacotherapy with non-medicinal therapies (education, exercise, CBT) is crucial.
- Optimizing fibromyalgia management requires addressing the central pain mechanisms.
Related Concept Videos
01:28Drug Therapy
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety Medications
01:23Antidepressant Drugs: MAOIs and Other Agents
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
01:28Antidepressant Drugs: Tricyclics, SSRIs, and SNRIs
Tricyclic Antidepressants (TCAs), including Desipramine (Norpramin), Imipramine (Tofranil), Clomipramine (Anafranil), and Amitriptyline (Elavil), inhibit serotonin and norepinephrine reuptake and also block other receptors. They are used for depression, pain conditions, and insomnia. Common adverse effects include anticholinergic effects, sedation, orthostatic hypotension, and weight gain. They have a narrow therapeutic window and so require plasma-level monitoring. Abrupt discontinuation can...
01:17Drugs for Treatment of Diarrhea-Predominant IBS
Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
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,...