Pain management in fibromyalgia

University of Kentucky, Lexington, Kentucky 40536, USA.
Current Opinion in Rheumatology (Impact Factor: 4.89). 06/2008; 20(3):246-50. DOI: 10.1097/BOR.0b013e3282fb0268
Source: PubMed


Pain is the primary presenting symptom in the vast majority of inflammatory and noninflammatory rheumatic diseases. Patients tell us that improved pain relief is a principal concern. Many pain complaints respond incompletely to the treatment of the primary rheumatic disorder and pain syndromes such as fibromyalgia do not respond to traditional analgesic medications. Therefore, proper management requires consideration of additional medications for symptomatic relief. This review addresses newer strategies for the treatment of pain in patients with fibromyalgia that may be also useful in patients with other rheumatic diseases.
New medications have been developed with a better understanding of chronic pain mechanisms that principally address pain neurobiology at the levels of the spinal cord and the brain. Clinical studies demonstrate the effectiveness of the alpha-2-delta ligands (gabapentin and pregabalin) and the norepinephrine/serotonin reuptake inhibitors (duloxetine and milnacipran) in fibromyalgia.
Patients with chronic pain, best classified as fibromyalgia, either primary or in association with other rheumatic disorders, may experience benefit from new therapies targeting central pain mechanisms.

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    • "However, stress reduction treatment interventions have shown promise in reducing or alleviating aberrant cortisol rhythms that can occur with chronic illnesses including fibromyalgia [19] and cancer [20, 21] . Fibromyalgia is sometimes managed with antiinflammatory and/or anti-depressant medications, and agents targeting central pain mechanisms have recently shown prom- ise [22, 23]. However, recent meta-analyses conclude that optimal treatment interventions should include components aimed at enhancing relaxation, cognitive and behavioral responses , exercise, health education, and pharmacotherapy [24, 25] . "
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    ABSTRACT: Several recent reviews have evaluated evidence on the efficacy of Mindfulness-Based Stress Reduction (MBSR) among fibromyalgia sufferers, and concluded that more research should test effects on both psychological and physiological functioning. We conducted a randomized prospective trial of MBSR among female fibromyalgia patients. Effects on perceived stress, pain, sleep quality, fatigue, symptom severity, and salivary cortisol were tested in treatment (n = 51) versus wait-list control participants (n = 40) using data at baseline, post-program, and 2-month follow-up. Analyses revealed that MBSR significantly reduced perceived stress, sleep disturbance, and symptom severity, with gains maintained at follow-up. Greater home practice at follow-up was associated with reduced symptom severity. MBSR did not significantly alter pain, physical functioning, or cortisol profiles. MBSR ameliorated some of the major symptoms of fibromyalgia and reduced subjective illness burden. Further exploration of MBSR effects on physiological stress responses is warranted. These results support use of MBSR as a complementary treatment for women with fibromyalgia (ISRCTN: 34628811).
    Full-text · Article · Nov 2014 · Annals of Behavioral Medicine
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    • "Treatment for fibromyalgia includes pharmacological treatment, behavioral intervention, physical therapy, exercises, and alternative medicine.40–48 Although fibromyalgia patients often use analgesics, antidepressants, anticonvulsants, opioids, dopamine agonists, and other medications to alleviate their symptoms, the only pharmacologic treatments approved by the US Food and Drug Administration (FDA) for fibromyalgia are pregabalin (approved in 2007),49–53 duloxetine (approved in 2008),53–56 and milnacipran (approved in 2009).57–59 "
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    ABSTRACT: To compare health care utilization of duloxetine initiators and pregabalin initiators among fibromyalgia patients in a real-world setting. A retrospective cohort study was conducted based on a US national commercial health claims database (2006-2009). Fibromyalgia patients who initiated duloxetine or pregabalin in 2008, aged 18-64 years, and who maintained continuous health insurance coverage 1 year before and 1 year after initiation were assigned to duloxetine or pregabalin cohorts on the basis of their initiated agent. Patients who had pill coverage of the agents over the course of 90 days preceding the initiation were excluded. The two comparative cohorts were constructed using propensity score greedy match methods. Descriptive analysis and paired t-test were performed to compare health care utilization rates in the postinitiation year and the changes of these rates from the preinitiation year to the postinitiation year. Both matched cohorts (n=1,265 pairs) had a similar mean initiation age (49-50 years), percentage of women (87%-88%), and prevalence of baseline comorbid conditions (neuropathic pain other than diabetic peripheral neuropathic pain, low back pain, cardiovascular disease, hypertension, headache or migraine, and osteoarthritis). In the preinitiation year, both cohorts had similar inpatient, outpatient, and medication utilization rates (inpatient, 15.7%-16.1%; outpatient, 100.0%; medication, 97.9%-98.7%). The utilization rates diverged in the postinitiation year, with the pregabalin cohort using more fibromyalgia-related inpatient care (3.2% versus 2.2%; P<0.05), any inpatient care (19.3% versus 16.8%; P<0.05), and fibromyalgia-related outpatient care (62.1% versus 51.8%; P<0.05). From the preinitiation period to the postinitiation period, the duloxetine cohort experienced decreases in certain utilization rates, whereas the pregabalin cohort had increases (percentage of patients with a fibromyalgia-related admission, -1.2% versus 0.4% [P<0.01]; number of fibromyalgia-related outpatient claims, -1.7 versus 4.7 [P<0.01]). Fibromyalgia patients initiating pregabalin tended to consume more fibromyalgia-related inpatient and outpatient care in the first postinitiation year, whereas fibromyalgia patients initiating duloxetine tended to have lower utilization rates of fibromyalgia-related inpatient care in the postinitiation year than in the preinitiation year.
    Full-text · Article · Jan 2014 · Journal of Pain Research
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    • "Evidence-based treatment guidelines include those developed by the American Pain Society (APS) in 2005 and the European League Against Rheumatism (EULAR) in 2008 [49] [78]. Recent reviews of treatment options state that there is good to moderate evidence for efficacy of over 20 treatment interventions in FMS, highlighting the uncertainty in management of these patients [79]. Approval of several drugs by the FDA in recent years, for example, pregabalin, duloxetine, and milnacipran, has been of great help in alleviating symptoms. "
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    ABSTRACT: Fibromyalgia (FMS) is a valid clinical condition that affects 2%-4% of the population with a pivot symptom of widespread body pain. The cause and cure of FMS are as yet unknown. The concept of FMS has evolved over the past two decades to incorporate symptoms beyond pain as contributing to the global spectrum of suffering. FMS is now recognized to be grounded in the neurological domain with evidence of dysregulation of pain processing. Appreciation of the neurophysiologic mechanisms operative in FMS has contributed to rational treatment recommendations, although a "gold standard treatment" does not currently exist. Ideal treatments for FMS patients should be individualized with emphasis on active patient participation, good health practices, and multimodal intervention, incorporating nonpharmacologic and pharmacologic treatments. Predictors of outcome, which is favourable in over 50% of patients, are unknown, but those with better outcome do more physical activity and use fewer medications.
    Full-text · Article · Jan 2012 · Pain Research and Treatment
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