Fibromyalgia medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
There is no universally accepted treatment for fibromyalgia. Treatment typically consists of | There is no universally accepted treatment for fibromyalgia. Treatment typically consists of symptomic management and the treatment options include [[medications]] and [[cognitive behavioral therapy]], which has been shown to be effective in alleviating [[pain]] and other fibromyalgia-related symptoms. | ||
==Medical Therapy== | ==Medical Therapy== | ||
The medical therapy for fibromyalgia includes [[analgesics]], [[antidepressants]], such as [[Tricyclic antidepressant|TCA]]<nowiki/>s or [[Serotonin-norepinephrine reuptake inhibitor|SNRI]]<nowiki/>s, skeletal [[muscle relaxants]], [[anticonvulsants]], and [[Anti-anxiety drugs|anti-anxiety medications.]]<ref>{{cite book |author=Selfridge, Dr. Nancy, and Peterson, Franklynn|title=Freedom from Fibromyalgia: The 5-Week Program Proven to Conquer Pain |year=2001| isbn=0-8129-3375-3 }}</ref> | |||
===Single agent therapy=== | ===Single agent therapy=== | ||
*Preferred regimen (1): [[Amitriptyline]] 10-70 mg orally once daily at bedtime | *Preferred regimen (1): [[Amitriptyline]] 10-70 mg orally once daily at bedtime | ||
| Line 14: | Line 14: | ||
*Preferred regimen (4): [[Milnacipran]] 12.5 mg orally once daily initially, followed by 12.5 mg twice daily for 2 days, followed by 25 mg twice daily for 4 days, then 50-100 mg twice daily thereafter | *Preferred regimen (4): [[Milnacipran]] 12.5 mg orally once daily initially, followed by 12.5 mg twice daily for 2 days, followed by 25 mg twice daily for 4 days, then 50-100 mg twice daily thereafter | ||
*Preferred regimen (5): [[Pregabalin]] 75-225 mg orally twice daily, maximum 450 mg/day | *Preferred regimen (5): [[Pregabalin]] 75-225 mg orally twice daily, maximum 450 mg/day | ||
===Combination | ===Combination Therapy=== | ||
*Preferred regimen (1): [[Amitriptyline]] 10-70 mg orally once daily at bedtime '''(OR)''' | *Preferred regimen (1): [[Amitriptyline]] 10-70 mg orally once daily at bedtime '''(OR)''' | ||
*Preferred regimen (2): [[Cyclobenzaprine]] 5-30 mg orally once daily at bedtime | *Preferred regimen (2): [[Cyclobenzaprine]] 5-30 mg orally once daily at bedtime | ||
'''AND''' | '''AND''' | ||
*Preferred regimen (3): [[Duloxetine]] 30-60 mg orally once daily; higher doses have been used, consult specialist for guidance '''(OR)''' | *Preferred regimen (3): [[Duloxetine]] 30-60 mg orally once daily; higher doses have been used, consult a specialist for guidance '''(OR)''' | ||
*Preferred regimen (4): [[Milnacipran]] 12.5 mg orally once daily initially, followed by 12.5 mg twice daily for 2 days, followed by 25 mg twice daily for 4 days, then 50-100 mg twice daily thereafter | *Preferred regimen (4): [[Milnacipran]] 12.5 mg orally once daily initially, followed by 12.5 mg twice daily for 2 days, followed by 25 mg twice daily for 4 days, then 50-100 mg twice daily thereafter | ||
'''AND''' | '''AND''' | ||
*Preferred regimen (5): [[Pregabalin]] 75-225 mg orally twice daily, maximum 450 mg/day '''(OR)''' | *Preferred regimen (5): [[Pregabalin]] 75-225 mg orally twice daily, maximum 450 mg/day '''(OR)''' | ||
*Preferred regimen (6): [[Gabapentin]] 300 mg orally once daily on the first day, followed by 300 mg twice daily on the second day, followed by 300 mg three times daily on the third day, then [[titrate]] dose according to response up to 1800-2400 mg/day given in 3 divided doses | *Preferred regimen (6): [[Gabapentin]] 300 mg orally once daily on the first day, followed by 300 mg twice daily on the second day, followed by 300 mg three times daily on the third day, then [[titrate]] dose according to response up to 1800-2400 mg/day given in 3 divided doses | ||
==Underlying randomized studies of treatment== | |||
===Vitamin D=== | |||
Although initial studies suggest that low [[vitamin D]] levels may be associated with nonspecific musculoskeletal pain<ref name="pmid14661675">{{cite journal|author=Plotnikoff GA, Quigley JM |title=Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain |journal=Mayo Clin. Proc.|volume=78 |issue=12 |pages=1463–70 |year=2003 |pmid=14661675 |doi=}}</ref>; more recent studies make this doubtful.<ref name="pmid18431091">{{cite journal|author=Warner AE, Arnspiger SA |title=Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D |journal=J Clin Rheumatol |volume=14 |issue=1 |pages=12–6 |year=2008 |month=February |pmid=18431091 |doi=10.1097/RHU.0b013e31816356a9 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00124743-200802000-00003 |issn=}}</ref><ref name="pmid19364687">{{cite journal| author=Arvold DS, Odean MJ, Dornfeld MP, Regal RR, Arvold JG, Karwoski GC et al.| title=Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial. | journal=Endocr Pract | year= 2009 | volume= 15 | issue= 3 | pages= 203-12 | pmid=19364687 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19364687 }} </ref> | |||
Trials conflict whether Vitamin D is beneficial.<ref name="pmid19364687">{{cite journal| author=Arvold DS, Odean MJ, Dornfeld MP, Regal RR, Arvold JG, Karwoski GC et al.| title=Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial. | journal=Endocr Pract | year= 2009 | volume= 15 | issue= 3 | pages= 203-12 | pmid=19364687 | doi=10.4158/EP.15.3.203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19364687 }} </ref><ref name="pmid18431091">{{cite journal| author=Warner AE, Arnspiger SA| title=Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D. | journal=J Clin Rheumatol | year= 2008 | volume= 14 | issue= 1 | pages= 12-6 | pmid=18431091 | doi=10.1097/RHU.0b013e31816356a9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18431091 }} </ref> | |||
* Benefit was found in trials that were not prospectively registered.<ref name="pmid19364687">{{cite journal| author=Arvold DS, Odean MJ, Dornfeld MP, Regal RR, Arvold JG, Karwoski GC et al.| title=Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial. | journal=Endocr Pract | year= 2009 | volume= 15 | issue= 3 | pages= 203-12 | pmid=19364687 | doi=10.4158/EP.15.3.203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19364687 }} </ref><ref name="pmid24438771">{{cite journal| author=Wepner F, Scheuer R, Schuetz-Wieser B, Machacek P, Pieler-Bruha E, Cross HS et al.| title=Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. | journal=Pain | year= 2014 | volume= 155 | issue= 2 | pages= 261-8 | pmid=24438771 | doi=10.1016/j.pain.2013.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24438771 }} </ref> | |||
* Benefit was found in a case series.<ref name="pmid27860257">{{cite journal| author=Yilmaz R, Salli A, Cingoz HT, Kucuksen S, Ugurlu H| title=Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency. | journal=Int J Rheum Dis | year= 2016 | volume= 19 | issue= 12 | pages= 1255-1262 | pmid=27860257 | doi=10.1111/1756-185X.12960 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27860257 }} </ref> | |||
A [[meta-analysis]] concludes that Vitamin D reduces pain.<ref name="pmid28812209">{{cite journal| author=Yong WC, Sanguankeo A, Upala S| title=Effect of vitamin D supplementation in chronic widespread pain: a systematic review and meta-analysis. | journal=Clin Rheumatol | year= 2017 | volume= 36 | issue= 12 | pages= 2825-2833 | pmid=28812209 | doi=10.1007/s10067-017-3754-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28812209 }} </ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 20:08, 17 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
There is no universally accepted treatment for fibromyalgia. Treatment typically consists of symptomic management and the treatment options include medications and cognitive behavioral therapy, which has been shown to be effective in alleviating pain and other fibromyalgia-related symptoms.
Medical Therapy
The medical therapy for fibromyalgia includes analgesics, antidepressants, such as TCAs or SNRIs, skeletal muscle relaxants, anticonvulsants, and anti-anxiety medications.[1]
Single agent therapy
- Preferred regimen (1): Amitriptyline 10-70 mg orally once daily at bedtime
- Preferred regimen (2): Cyclobenzaprine 5-30 mg orally once daily at bedtime
- Preferred regimen (3): Duloxetine 30-60 mg orally once daily
- Preferred regimen (4): Milnacipran 12.5 mg orally once daily initially, followed by 12.5 mg twice daily for 2 days, followed by 25 mg twice daily for 4 days, then 50-100 mg twice daily thereafter
- Preferred regimen (5): Pregabalin 75-225 mg orally twice daily, maximum 450 mg/day
Combination Therapy
- Preferred regimen (1): Amitriptyline 10-70 mg orally once daily at bedtime (OR)
- Preferred regimen (2): Cyclobenzaprine 5-30 mg orally once daily at bedtime
AND
- Preferred regimen (3): Duloxetine 30-60 mg orally once daily; higher doses have been used, consult a specialist for guidance (OR)
- Preferred regimen (4): Milnacipran 12.5 mg orally once daily initially, followed by 12.5 mg twice daily for 2 days, followed by 25 mg twice daily for 4 days, then 50-100 mg twice daily thereafter
AND
- Preferred regimen (5): Pregabalin 75-225 mg orally twice daily, maximum 450 mg/day (OR)
- Preferred regimen (6): Gabapentin 300 mg orally once daily on the first day, followed by 300 mg twice daily on the second day, followed by 300 mg three times daily on the third day, then titrate dose according to response up to 1800-2400 mg/day given in 3 divided doses
Underlying randomized studies of treatment
Vitamin D
Although initial studies suggest that low vitamin D levels may be associated with nonspecific musculoskeletal pain[2]; more recent studies make this doubtful.[3][4]
Trials conflict whether Vitamin D is beneficial.[4][3]
- Benefit was found in trials that were not prospectively registered.[4][5]
- Benefit was found in a case series.[6]
A meta-analysis concludes that Vitamin D reduces pain.[7]
References
- ↑ Selfridge, Dr. Nancy, and Peterson, Franklynn (2001). Freedom from Fibromyalgia: The 5-Week Program Proven to Conquer Pain. ISBN 0-8129-3375-3.
- ↑ Plotnikoff GA, Quigley JM (2003). "Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain". Mayo Clin. Proc. 78 (12): 1463–70. PMID 14661675.
- ↑ 3.0 3.1 Warner AE, Arnspiger SA (2008). "Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D". J Clin Rheumatol. 14 (1): 12–6. doi:10.1097/RHU.0b013e31816356a9. PMID 18431091. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 4.2 Arvold DS, Odean MJ, Dornfeld MP, Regal RR, Arvold JG, Karwoski GC; et al. (2009). "Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial". Endocr Pract. 15 (3): 203–12. PMID 19364687.
- ↑ Wepner F, Scheuer R, Schuetz-Wieser B, Machacek P, Pieler-Bruha E, Cross HS; et al. (2014). "Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial". Pain. 155 (2): 261–8. doi:10.1016/j.pain.2013.10.002. PMID 24438771.
- ↑ Yilmaz R, Salli A, Cingoz HT, Kucuksen S, Ugurlu H (2016). "Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency". Int J Rheum Dis. 19 (12): 1255–1262. doi:10.1111/1756-185X.12960. PMID 27860257.
- ↑ Yong WC, Sanguankeo A, Upala S (2017). "Effect of vitamin D supplementation in chronic widespread pain: a systematic review and meta-analysis". Clin Rheumatol. 36 (12): 2825–2833. doi:10.1007/s10067-017-3754-y. PMID 28812209.