Fibromyalgia syndrome: the pharmacological treatment options

Sarzi-Puttini, Piercarlo; Torta, Riccardo; Marinangeli, Franco; Biasi, Giovanni; Späth, M.; Buskila, Dan; Gracely, Richard H.; Giamberardino, Maria Adele; Bazzichi, Laura; Cazzola, M.; Franco, Manuela Di; Stisi, S.; Salaffi, Fausto; Casale, Roberto; Leardini, G.; Gorla, Roberto; Marsico, A.; Carignola, R.; Altomonte, L; Ceccherelli, Francesco; Cassisi, G.; Arioli, G.; Alciati, Alessandra; Atzeni, Fabiola

doi:10.4081/reumatismo.2008.1s.50

Cited by 10 publications

(14 citation statements)

References 105 publications

(58 reference statements)

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“…Tramadol has a mechanism of action that differs from that of opioids, in that it includes not only weak agonist activity at the mu-opioid receptor but also inhibition of the reuptake of serotonin and norepinephrine. 28 Tramadol has been shown to have less addictive potential than opioids, 23 and is not classified as a controlled medication. For these reasons, both tramadol and nonopioid medications might be considered before opioid use, as has been suggested in the literature.…”

Section: Discussionmentioning

confidence: 99%

Long-term Evaluation of Opioid Treatment in Fibromyalgia

Peng

Robinson

Mease

et al. 2015

The Clinical Journal of Pain

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Section: Discussionmentioning

confidence: 99%

Long-term Evaluation of Opioid Treatment in Fibromyalgia

Peng

Robinson

Mease

et al. 2015

The Clinical Journal of Pain

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“…There is strong evidence in favour of dual re-uptake inhibitors such as tricyclic compounds (amitriptyline, cyclobenzaprine) and serotonin-norepinephrine reuptake inhibitors (milnacipram, duloxetine, venlafaxine) and for anticonvulsants (pregabalin and gabapentin); moderate evidence for tramadol, selective serotonin reuptake inhibitors, gamma hydroxybutyrate and dopamine agonists; and weak evidence for growth hormone, 5-hydroxytriptamine, tropisetron, S-adenosyl-L-methionin. There is no evidence in favour of opioids, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), or the benzodiazepines, and some data suggest that giving opioids to patients with central pain states might even worsen the pain (1,104,105). The European League Against Rheumatism recommendations share this pharmacotherapeutic grading, but also strongly recommend tramadol and pramipexole and state the potential effectiveness of simple analgesics such as paracetamol and other weak opioids (99).…”

Section: N Therapeutic Approachesmentioning

confidence: 99%

Pain in fibromyalgia and related conditions

Cassisi¹,

Sarzi-Puttini

Casale

et al. 2014

Reumatismo

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Pain is the hallmark symptom of fibromyalgia (FM) and other related syndromes, but quite different from that of other rheumatic diseases, which depends on the degree of damage or inflammation in peripheral tissues. Sufferers are often defined as patients with chronic pain without an underlying mechanistic cause, and these syndromes and their symptoms are most appropriately described as "central pain", "neuropathic pain", "nonnociceptive pain" or "central sensitivity syndromes". The pain is particular, regional or widespread, and mainly relates to the musculoskeletal system; hyperalgesia or allodynia are typical. Its origin is currently considered to be distorted pain or sensory processing, rather than a local or regional abnormality. FM is probably the most important and extensively described central pain syndrome, but the characteristics and features of FM-related pain are similar in other disorders of particular interest for rheumatologists, such as myofascial pain syndromes and temporo-mandibular joint disorders, and there is also an intriguing overlap between FM and benign joint hypermobility syndrome. This suggests that the distinctive aspects of pain in these idiopathic or functional conditions is caused by central nervous system hypersensitivity and abnormalities. Pharmacological and non-pharmacological therapies have been suggested for the treatment of these conditions, but a multidisciplinary approach is required in order to reduce the abnormal cycle of pain amplification and the related maladaptive and self-limiting behaviours.

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“…Il tramadolo, un agonista debole per i recettori m per gli oppioidi, un farmaco analgesico centrale, può ridurre la sintomatologia dolorosa del paziente con FM. I cortisonici sono inefficaci e dovrebbero essere evitati per i loro potenziali effetti collaterali [33]. I farmaci che favoriscono il sonno profondo e il rilassamento muscolare aiutano molti pazienti affetti da FM a riposare meglio.…”

Section: Terapiaunclassified

“…e gli inibitori selettivi del reuptake della serotonina (paroxetina, fluoxetina ecc.) e altri farmaci ad azione prevalentemente miorilassante, ma simili strutturalmente agli antidepressivi (ciclobenzaprina) [27,33]. Sebbene abbiano come principale indicazione la depressione, essi vengono abitualmente prescritti a bassi dosaggi ai pazienti affetti da FM, di solito prima di andare a letto.…”

Section: Terapiaunclassified

Update on fibromyalgia

Atzeni¹,

Cazzola

Sarzi‐Puttini

2012

Ital J Med

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IntroductionFibromyalgia (FM) is a chronic pain syndrome characterized by widespread pain, fatigue, sleep alterations, and distress. It affects at least 2% of the adult population. The etiology of FM is not completely understood, and the syndrome is influenced by stress, physical illness, and a variety of pain conditions. Emerging evidence indicates that augmented pain processing within the central nervous system plays a primary role in the pathophysiology of this disorder. Diagnosis may be difficult because of the multifaceted nature of the syndrome and its overlap with other chronically painful conditions. This article reviews the most recent data in the literature on FM.Materials and methodsThere are currently no instrumental tests or specific diagnostic markers for FM. In fact, many of the existing indicators are regarded as significant for research purposes only.ResultsDifferential diagnosis requires an extensive clinical examination and complete patient history. Chest-X-rays and abdominal ultrasonography are the first steps in the general evaluation of a patient with suspected FM.ConclusionsA variety of pharmacological treatments have been used to treat FM, including antidepressants, nonsteroidal anti-inflammatory drugs, opioids, sedatives, muscle relaxants, and antiepileptics. Physical exercise and multimodal cognitive-behavioral therapy seem to be the most widely accepted and beneficial forms of non-pharmacological therapy.

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Fibromyalgia syndrome: the pharmacological treatment options

Cited by 10 publications

References 105 publications

Long-term Evaluation of Opioid Treatment in Fibromyalgia

Long-term Evaluation of Opioid Treatment in Fibromyalgia

Pain in fibromyalgia and related conditions

Update on fibromyalgia

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