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| ==Overview== | | ==Overview== |
| ==Medical Therapy== | | ==Medical Therapy== |
| As with many other syndromes, there is no universally accepted cure for fibromyalgia, though some physicians claim to have found cures.<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> However, a steady interest in the disorder on the part of academic researchers as well as pharmaceutical interests has led to improvements in its treatment, which ranges from symptomatic prescription medication to [[alternative medicine|alternative]] and [[complementary medicine]]. | | As with many other syndromes, there is no universally accepted cure for fibromyalgia.<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=== |
| The European League Against Rheumatism (EULAR) issued the first guidelines for the treatment of fibromyalgia syndrome (FMS) and published them in the September 17th On-line First issue of the Annals of the Rheumatic Diseases.
| | *Preferred regimen (1): Amitriptyline 10-70 mg orally once daily at bedtime |
| | | *Preferred regimen (2): Cyclobenzaprine 5-30 mg orally once daily at bedtime |
| Many medications are used to treat specific symptoms of fibromyalgia, such as muscle pain and insomnia.
| | *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 |
| [[Image:Fibromyalgia_treatment.png|left|400px]]
| | *Preferred regimen (5): Pregabalin 75-225 mg orally twice daily, maximum 450 mg/day |
| | | ===Combination Thereapy=== |
| ==== Pain Relief ==== | | *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 |
| A number of pain relievers have been prescribed for fibromyalgia. This includes [[NSAID]] medications over the counter, COX-2 inhibitors, and [[tramadol]] in prescription form for more advanced cases. Recently, [[pregabalin]] (marketed as Lyrica) has been given FDA approval for the treatment of diagnosed Fibromyalgia.
| | '''AND''' |
| | | *Preferred regimen (3): Duloxetine 30-60 mg orally once daily; higher doses have been used, consult specialist for guidance '''(OR)''' |
| ====Muscle Relaxants====
| | *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''' |
| Muscle relaxants, such as [[cyclobenzaprine]] (Flexeril) or [[tizanidine]] (Zanaflex), may be used to treat the muscle pain associated with the disorder.
| | *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 first day, followed by 300 mg twice daily on second day, followed by 300 mg three times daily on third day, then titrate dose according to response up to 1800-2400 mg/day given in 3 divided doses |
| ====Tricyclic antidepressants (TCAs)====
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| Traditionally, low doses of sedating antidepressants (e.g. [[amitriptyline]] and [[trazodone]]) have been used to reduce the sleep disturbances that are associated with fibromyalgia and are believed by some practitioners to alleviate the symptoms of the disorder. Because depression often accompanies chronic illness, these antidepressants may provide additional benefits to patients suffering from depression. [[Amitriptyline]] is often favoured as it can also have the effect of providing relief from neuralgenic or [[Neuropathy|neuropathic pain]]. It is to be noted that Fibromyalgia is not considered a depressive disorder; antidepressants are used for their sedating effect to aid in sleep.
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| ====Selective serotonin reuptake inhibitors (SSRIs)====
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| Research data consistently contradict the utility of agents with specificity as serotonin reuptake inhibitors for the treatment of core symptoms of fibromyalgia. <ref>[http://www.ncbi.nlm.nih.gov/pubmed/7478688?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum A randomized controlled trial of citalopram in the...[Pain. 1995] - PubMed Result<!-- Bot generated title -->]</ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/10833553?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus Citalopram in patients with fibromyalgia-a random...[Eur J Pain. 2000] - PubMed Result<!-- Bot generated title -->]</ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/17466657?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum A randomized, controlled, trial of controlled rele...[Am J Med. 2007] - PubMed Result<!-- Bot generated title -->]</ref> Moreover, SSRIs are known to aggravate many of the comorbidities that commonly affect patients with fibromyalgia including restless legs syndrome and sleep bruxism<ref>[http://www.ncbi.nlm.nih.gov/pubmed/9416386?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Extrapyramidal reactions and the selective seroton...[Ann Pharmacother. 1997] - PubMed Result<!-- Bot generated title -->]</ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/8909330?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Movement disorders associated with the serotonin s...[J Clin Psychiatry. 1996] - PubMed Result<!-- Bot generated title -->]</ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/9640489?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Selective serotonin-reuptake inhibitor-induced mov...[Ann Pharmacother. 1998] - PubMed Result<!-- Bot generated title -->]</ref>.
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| ====Anti-seizure drugs====
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| Anti-seizure drugs are also sometimes used, such as [[gabapentin]]<ref>Arnold LM, Goldenberg DL, Stanford SB, et. al. Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial.
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| Arthritis Rheum. 2007 Apr;56(4):1336-44</ref> and [[pregabalin]] (Lyrica). [[Pregabalin]], originally used for the nerve pain suffered by diabetics, has been approved by the American [[Food and Drug Administration]] for treatment of fibromyalgia. A [[randomized controlled trial]] of [[pregabalin]] 450 mg/day found that a [[number needed to treat]] of 6 patients for one patient to have 50% reduction in pain.<ref name="pmid15818684">{{cite journal |author=Crofford LJ, Rowbotham MC, Mease PJ, ''et al'' |title=Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial |journal=Arthritis Rheum. |volume=52 |issue=4 |pages=1264-73 |year=2005 |pmid=15818684 |doi=10.1002/art.20983}}</ref>
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| ====Dopamine agonists====
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| [[Dopamine agonists]] (e.g. [[pramipexole]] (Mirapex) and [[ropinirole]] (ReQuip)) have been studied for use in the treatment of fibromyalgia with good results. <ref>{{cite journal |author=Andrew J. Holman and Robin R. Myers |title=A Randomized, Double-Blind, Placebo-Controlled Trial of Pramipexole, a Dopamine Agonist, in Patients With Fibromyalgia Receiving Concomitant Medications |journal=Arthritis and Rheumatism |volume=52 |issue=8 |pages=2495-2505 |year=2005}}</ref> A trial of transdermal [[rotigotine]] is currently on going <ref>[http://clinicaltrials.gov/ct2/show/NCT00464737 A Double-Blind Multicenter Proof of Concept Trial to Assess the Efficacy and Safety of Rotigotine in Subjects With Fibromyalgia Syndrome - Full Text View - ClinicalTrials.gov<!-- Bot generated title -->]</ref>.
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| ====Combination therapy====
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| A controlled clinical trial of [[amitriptyline]] and [[fluoxetine]] demonstrated utility when used in combination.<ref name="pmid8912507">{{cite journal |author=Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmid C |title=A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia |journal=Arthritis Rheum. |volume=39 |issue=11 |pages=1852-9 |year=1996 |pmid=8912507 |doi=}}</ref>
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| ====Cannabis and cannabinoids====
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| Fibromyalgia patients frequently self-report using [[cannabis (drug)|cannabis]] therapeutically to treat symptoms of the disorder.<ref name="pmid16202145">{{cite journal |author=Swift W, Gates P, Dillon P |title=Survey of Australians using cannabis for medical purposes |journal=Harm reduction journal |volume=2 |issue= |pages=18 |year=2005 |pmid=16202145 |doi=10.1186/1477-7517-2-18 |url=http://www.biomedcentral.com/content/pdf/1477-7517-2-18.pdf |format=PDF}}</ref> Writing in the July 2006 issue of the journal Current Medical Research and Opinion, investigators at Germany's University of Heidelberg evaluated the analgesic effects of oral THC ([[tetrahydrocannabinol|∆<sup>9</sup>-tetrahydrocannabinol]]) in nine patients with fibromyalgia over a 3-month period. Subjects in the trial were administered daily doses of 2.5 to 15 mg of THC, but received no other pain medication during the trial. Among those participants who completed the trial, all reported a significant reduction in daily recorded pain and electronically induced pain.<ref name="pmid16834825">{{cite journal |author=Schley M, Legler A, Skopp G, Schmelz M, Konrad C, Rukwied R |title=Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief |journal=Current medical research and opinion |volume=22 |issue=7 |pages=1269–76 |year=2006 |pmid=16834825 |doi=10.1185/030079906X112651}}</ref> Previous clinical and preclinical trials have shown that both naturally occurring and endogenous cannabinoids hold analgesic qualities,<ref>{{cite journal |author=Burnes TL, Ineck JR |title=Cannabinoid Analgesia as a Potential New Therapeutic Option in the Treatment of Chronic Pain |journal=Annals of Pharmacotherapy |year= |volume=40 |issue=2 |pages=251-60 |doi=10.1345/aph.1G217 |url=http://www.theannals.com/cgi/content/full/40/2/251}}</ref> particularly in the treatment of cancer pain and neuropathic pain,<ref name="pmid15757410">{{cite journal |author=Radbruch L, Elsner F |title=Emerging analgesics in cancer pain management |journal=Expert opinion on emerging drugs |volume=10 |issue=1 |pages=151–71 |year=2005 |pmid=15757410 |doi=}}</ref><ref name="pmid15096238">{{cite journal |author=Notcutt W, Price M, Miller R, ''et al'' |title=Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 'N of 1' studies |journal=Anaesthesia |volume=59 |issue=5 |pages=440–52 |year=2004 |pmid=15096238 |doi=10.1111/j.1365-2044.2004.03674.x}}</ref> both of which are poorly treated by conventional opioids. As a result, some experts have suggested that cannabinoid agonists would be applicable for the treatment of chronic pain conditions unresponsive to opioid analgesics such as fibromyalgia, and they propose that the disorder may be associated with an underlying clinical deficiency of the [[endocannabinoid system]].<ref name="pmid15159679">{{cite journal |author=Russo EB |title=Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? |journal=Neuro Endocrinol. Lett. |volume=25 |issue=1-2 |pages=31–9 |year=2004 |pmid=15159679 |doi=}}</ref>
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| ====Topical Remedies====
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| Users of Epsom Salts in the gel form ([[Magnesium Sulfate]]), have reported significant and lasting relief from pain associated with fibromyalgia. Epsom Salts have long been touted for its ability to reduce pain and swelling.
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| ====Injection Therapy====
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| Interventional therapy can ease pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, proliferative agents ([[Prolotherapy]]) into affected soft tissues, joints, or nerve roots to more complex nerve blocks. Chronic use of steroid injections may lead to increased functional impairment.
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| ====Physical treatments====
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| Studies have found exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia.<ref name="pmid12137713">{{cite journal |author=Busch A, Schachter CL, Peloso PM, Bombardier C |title=Exercise for treating fibromyalgia syndrome |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD003786 |year=2002 |pmid=12137713 |doi=}}</ref> Many patients find temporary relief by applying heat to painful areas. Those with access to [[physical therapy]], [[massage]], or acupuncture may find them beneficial.<ref name="pmid10086765">{{cite journal |author=Berman BM, Ezzo J, Hadhazy V, Swyers JP |title=Is acupuncture effective in the treatment of fibromyalgia? |journal=The Journal of family practice |volume=48 |issue=3 |pages=213–8 |year=1999 |pmid=10086765 |doi=}}</ref> Most patients find exercise, even low intensity exercise to be extremely helpful.<ref name="pmid14770100">{{cite journal |author=Gowans SE, deHueck A |title=Effectiveness of exercise in management of fibromyalgia |journal=Current opinion in rheumatology |volume=16 |issue=2 |pages=138–42 |year=2004 |pmid=14770100 |doi=}}</ref> [[Osteopathic Manipulative Medicine|Osteopathic manipulative therapy]] can also temporarily relieve pain due to fibromyalgia.<ref name="pmid12090649">{{cite journal |author=Gamber RG, Shores JH, Russo DP, Jimenez C, Rubin BR |title=Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project |journal=The Journal of the American Osteopathic Association |volume=102 |issue=6 |pages=321–5 |year=2002 |pmid=12090649 |doi= |url=http://www.jaoa.org/cgi/reprint/102/6/321.pdf |format=PDF}}</ref>
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| Transcutaneous electrical nerve stimulation (TENS) is administered by a battery-powered device that sends mild electric pulses along nerve fibers to block pain signals to the brain. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that block incoming pain signals from the peripheral nerves. TENS may also help stimulate the brain’s production of endorphins (chemicals that have pain-relieving properties).
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| A holistic approach—including managing diet, sleep, stress, activity, and pain—is used by many patients. Dietary supplements, massage, chiropractic care, managing blood sugar levels, and avoiding known triggers when possible means living as well as it is in the patient's power to do.
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| ====Dietary treatment====
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| In a 2001 review of four case studies, symptom alleviation was found by minimizing consumption of [[monosodium glutamate]].<ref>Smith et al, Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins, Ann Pharmacother. 2001 Jun;35(6):702-6.</ref>
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| ==References== | | ==References== |