Fibromyalgia: Difference between revisions

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imported>Robert Badgett
imported>Robert Badgett
Line 36: Line 36:
#"Other therapies such as relaxation, rehabilitation, physiotherapy and psychological support may be used depending on the needs of the individual patient    (IIb    C)
#"Other therapies such as relaxation, rehabilitation, physiotherapy and psychological support may be used depending on the needs of the individual patient    (IIb    C)
Pharmacological management
Pharmacological management
#"Tramadol is recommended for the management of pain in fibromyalgia"    (Ib     A)
#"Tramadol is recommended for the management of pain in fibromyalgia"    (Ib A)
#"Simple analgesics such as [[paracetamol]] and other weak opioids can also be considered in the treatment of fibromyalgia. [[Corticosteroid]]s and strong opioids are not recommended    (IV    D)
#"Simple analgesics such as [[paracetamol]] and other weak opioids can also be considered in the treatment of fibromyalgia. [[Corticosteroid]]s and strong opioids are not recommended    (IV    D)
#"Antidepressants: [[amitriptyline]], [[fluoxetine]], [[duloxetine]], [[milnacipran]], [[moclobemide]] and [[pirlindole]], reduce pain and often improve function, therefore they are recommended for the treatment of fibromyalgia"    (Ib    A)
#"Antidepressants: [[amitriptyline]], [[fluoxetine]], [[duloxetine]], [[milnacipran]], [[moclobemide]] and [[pirlindole]], reduce pain and often improve function, therefore they are recommended for the treatment of fibromyalgia"    (Ib    A)
#[[Tropisetron]], [[pramipexole]] and [[pregabalin]] reduce pain and are recommended for the treatment of fibromyalgia"    (Ib    A)
#[[Tropisetron]], [[pramipexole]] and [[pregabalin]] reduce pain and are recommended for the treatment of fibromyalgia"    (Ib    A)


[[Pregabalin]] (Lyrica) is approved for use in the United States by the [[Food and Drug Administration]] (FDA) for fibromyalgia. As compared to placebo, [[pregabalin]] benefits about 1 of every 6 people who use it if they are similar to the patients in a [[randomized controlled trial]]. In this trial, 29% of the patients who took the drug had a reduction in their pain versus 13% of the patients who took placebo.<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>
[[Pregabalin]] (Lyrica) is approved for use in the United States by the [[Food and Drug Administration]] (FDA) for fibromyalgia. As compared to placebo, [[pregabalin]] benefits about 1 of every 6 people who use it if they are similar to the patients in a [[randomized controlled trial]]. In this trial, 33% of the patients who took the drug had a reduction in their pain versus 13% of the patients who took placebo.<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>
 
[[Duloxetine]] (Cymbalta) although not currently (7/2008) approved for use in the United States by the [[Food and Drug Administration]] (FDA) for fibromyalgia. As compared to placebo, [[duloxetine]] 60 mg per day benefits about 1 of every 7 people who use it if they are similar to the patients in an [[randomized controlled trial]]. In this trial, 51% of the patients who took the drug had a ''30%'' reduction in their pain versus 36% of the patients who took placebo (data not reported for 50% reduction).<ref name="pmid18395345">{{cite journal |author=Russell IJ, Mease PJ, Smith TR, ''et al'' |title=Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial |journal=Pain |volume=136 |issue=3 |pages=432–44 |year=2008 |month=June |pmid=18395345 |doi=10.1016/j.pain.2008.02.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0304-3959(08)00114-0 |issn=}}</ref> This trial was sponsored by the makers of Cymbalta which increased the likelihood of [[publication bias]] towards positive results.


==References==
==References==
<references/>
<references/>

Revision as of 15:30, 17 July 2008

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Fibromyalgia is a disease of the muscles. It is defined as "a common nonarticular rheumatic syndrome characterized by myalgia and multiple points of focal muscle tenderness to palpation (trigger points). Muscle pain is typically aggravated by inactivity or exposure to cold. This condition is often associated with general symptoms, such as sleep disturbances, fatigue, stiffness, headaches, and occasionally depression. There is significant overlap between fibromyalgia and the chronic fatigue syndrome (fatigue syndrome, chronic). Fibromyalgia may arise as a primary or secondary disease process. It is most frequent in females aged 20 to 50 years." (From Adams et al., Principles of Neurology, 6th ed, p1494-95)".[1]

Etiology/causation

The cause is not clear; however, "patients with fibromyalgia experience pain differently from the general population".[2]

Genetics

Using self-report of "Chronic Widespread Pain" (CWP) as a surrogate marker for fibromyalgia, the Swedish Twin Registry suggests a modest genetic contribution:[3][4]

  • Monozygotic twins with CWP have a 15% chance that their twin sibling has CWP
  • Dizygotic twins with CWP have a 7% chance that their twin sibling has CWP

Abnormal sleep

Fibromyalgia is associated with alpha sleep.[5] However, it is unclear if this abnormal sleep pattern causes or follows fibromyalgia.

Vitamin D deficiency

Although initial studies suggest that low vitamin D levels may be associated with nonspecific musculoskeletal pain[6]; more recent studies make this doubtful.[7][7]

Symptoms

Symptoms from associated illnesses

Fluid retention might be associated with fibromyalgia.[8][9] This is difficult to interpret as normal patients may have a 9 pound diurnal variation in weight.[10]

Diagnosis

Differential diagnosis

A cohort study found that widespread pain significantly increased risk of subsequent diagnosis of cancer, especially breast cancer and prostate cancer.[11] The biological reason for this association is not clear.

Treatment

Clinical practice guidelines by the European League Against Rheumatism (EULAR) recommendations (parentheses contain levels of evidence and strength of recommendation) are included below.[12]
General

  1. "Full understanding of fibromyalgia requires comprehensive assessment of pain, function and psychosocial context. Fibromyalgia should be recognised as a complex and heterogeneous condition where there is abnormal pain processing and other secondary features" (IV D)
  2. "Optimal treatment requires a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities tailored according to pain intensity, function, associated features such as depression, fatigue and sleep disturbance in discussion with the patient" (IV D)

Non-pharmacological management

  1. "Heated pool treatment with or without exercise is effective in fibromyalgia" (IIa B)
  2. "Individually tailored exercise programmes, including aerobic exercise and strength training can be beneficial to some patients" with fibromyalgia" (IIb C). Subsequent to the 2008 EULAR clinical practice guidelines, a meta-analysis of randomized controlled trials found "aerobic-only training has beneficial effects on physical function and some FM symptoms. Strength-only training may improve FM symptoms, but requires further study."[13]
  3. "Cognitive behavioural therapy may be of benefit to some patients with fibromyalgia" IV D)
  4. "Other therapies such as relaxation, rehabilitation, physiotherapy and psychological support may be used depending on the needs of the individual patient (IIb C)

Pharmacological management

  1. "Tramadol is recommended for the management of pain in fibromyalgia" (Ib A)
  2. "Simple analgesics such as paracetamol and other weak opioids can also be considered in the treatment of fibromyalgia. Corticosteroids and strong opioids are not recommended (IV D)
  3. "Antidepressants: amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide and pirlindole, reduce pain and often improve function, therefore they are recommended for the treatment of fibromyalgia" (Ib A)
  4. Tropisetron, pramipexole and pregabalin reduce pain and are recommended for the treatment of fibromyalgia" (Ib A)

Pregabalin (Lyrica) is approved for use in the United States by the Food and Drug Administration (FDA) for fibromyalgia. As compared to placebo, pregabalin benefits about 1 of every 6 people who use it if they are similar to the patients in a randomized controlled trial. In this trial, 33% of the patients who took the drug had a reduction in their pain versus 13% of the patients who took placebo.[14]

Duloxetine (Cymbalta) although not currently (7/2008) approved for use in the United States by the Food and Drug Administration (FDA) for fibromyalgia. As compared to placebo, duloxetine 60 mg per day benefits about 1 of every 7 people who use it if they are similar to the patients in an randomized controlled trial. In this trial, 51% of the patients who took the drug had a 30% reduction in their pain versus 36% of the patients who took placebo (data not reported for 50% reduction).[15] This trial was sponsored by the makers of Cymbalta which increased the likelihood of publication bias towards positive results.

References

  1. ↑ National Library of Medicine. Fibromyalgia. Retrieved on 2007-11-13.
  2. ↑ Abeles AM, Pillinger MH, Solitar BM, Abeles M (2007). "Narrative review: the pathophysiology of fibromyalgia". Ann. Intern. Med. 146 (10): 726–34. PMID 17502633. [e]
  3. ↑ Kato K, Sullivan P, Evengård B, Pedersen N (2006). "Importance of genetic influences on chronic widespread pain". Arthritis Rheum. 54 (5): 1682-6. DOI:10.1002/art.21798. PMID 16646040. Research Blogging.
  4. ↑ Kato K, Sullivan P, Evengård B, Pedersen N (2006). "Chronic widespread pain and its comorbidities: a population-based study". Arch. Intern. Med. 166 (15): 1649-54. PMID 16908799.
  5. ↑ Roizenblatt S, Moldofsky H, Benedito-Silva AA, Tufik S (2001). "Alpha sleep characteristics in fibromyalgia". Arthritis Rheum. 44 (1): 222–30. DOI:<222::AID-ANR29>3.0.CO;2-K 10.1002/1529-0131(200101)44:1<222::AID-ANR29>3.0.CO;2-K. PMID 11212164. <222::AID-ANR29>3.0.CO;2-K Research Blogging.
  6. ↑ 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. [e]
  7. ↑ 7.0 7.1 Warner AE, Arnspiger SA (February 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. Research Blogging.
  8. ↑ Deodhar AA, Fisher RA, Blacker CV, Woolf AD (June 1994). "Fluid retention syndrome and fibromyalgia". Br. J. Rheumatol. 33 (6): 576–82. PMID 8205408. [e]
  9. ↑ Dunnigan MG, Henderson JB, Hole D, Pelosi AJ (November 2004). "Unexplained swelling symptoms in women (idiopathic oedema) comprise one component of a common polysymptomatic syndrome". QJM 97 (11): 755–64. DOI:10.1093/qjmed/hch126. PMID 15496531. Research Blogging.
  10. ↑ Denning DW, Dunnigan MG, Tillman J, Davis JA, Forrest CA (May 1990). "The relationship between 'normal' fluid retention in women and idiopathic oedema". Postgrad Med J 66 (775): 363–6. PMID 2371185. [e]
  11. ↑ McBeth J, Silman AJ, Macfarlane GJ (2003). "Association of widespread body pain with an increased risk of cancer and reduced cancer survival: a prospective, population-based study". Arthritis Rheum. 48 (6): 1686–92. DOI:10.1002/art.10973. PMID 12794837. Research Blogging.
  12. ↑ Carville SF, Arendt-Nielsen S, Bliddal H, et al (2008). "EULAR evidence-based recommendations for the management of fibromyalgia syndrome". Ann. Rheum. Dis. 67 (4): 536-41. DOI:10.1136/ard.2007.071522. PMID 17644548. Research Blogging.
  13. ↑ Busch AJ, Schachter CL, Overend TJ, Peloso PM, Barber KA (June 2008). "Exercise for fibromyalgia: a systematic review". J. Rheumatol. 35 (6): 1130–44. PMID 18464301. [e]
  14. ↑ Crofford LJ, Rowbotham MC, Mease PJ, et al (2005). "Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial". Arthritis Rheum. 52 (4): 1264–73. DOI:10.1002/art.20983. PMID 15818684. Research Blogging.
  15. ↑ Russell IJ, Mease PJ, Smith TR, et al (June 2008). "Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial". Pain 136 (3): 432–44. DOI:10.1016/j.pain.2008.02.024. PMID 18395345. Research Blogging.
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