Management of Fibromyalgia

Leventhal, Lawrence J.

doi:10.7326/0003-4819-131-11-199912070-00009

Cited by 91 publications

(64 citation statements)

References 59 publications

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“…are a hallmark of CMI. The primary reason to determine whether a CMI may be present is that these conditions involve prominent central rather than peripheral mechanisms, and thus both the pharmacologic (e.g., low doses of tricyclic compounds instead of nonsteroidal anti-inflamatory drugs) and nonpharmacologic (e.g., aerobic exercise and cognitive behavioral therapy) approaches would be quite different [Bradley, 1989;Clark, 1994;Leventhal, 1999].…”

Section: Discussionmentioning

confidence: 99%

Relationship between stress and pain in work‐related upper extremity disorders: The hidden role of chronic multisymptom illnesses*

Clauw

Williams

2002

American J Industrial Med

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A model is presented that unites seemingly disparate findings across numerous investigations and provides a framework for understanding how genetics, triggering events, stressors, and early life events can affect CNS activity. Resultant symptom expression (e.g., pain and fatigue) from central dysregulation would be expected to occur in a subset of individuals in the population, including a subset of individuals with work-related upper extremity disorders. Thus when symptoms such as pain and fatigue persist beyond a reasonable period, consideration of CMI and associated assessment and interventions focused on central mechanisms may be worthwhile.

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Section: Discussionmentioning

confidence: 99%

Relationship between stress and pain in work‐related upper extremity disorders: The hidden role of chronic multisymptom illnesses*

Clauw

Williams

2002

American J Industrial Med

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“…A number of pharmacological treatments have been studied with varying degrees of success including anticonvulsants, antispasticity agents, anxiolytics, sedatives and opioids (Leventhal, 1999).…”

Section: Introductionmentioning

confidence: 99%

A double-blind placebo-controlled trial of milnacipran in the treatment of fibromyalgia

Vitton

Gendreau

et al. 2004

Hum. Psychopharmacol. Clin. Exp.

172

135

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Fibromyalgia syndrome is a systemic disorder of widespread pain which is thought to result from abnormal pain processing within the central nervous system. There are no currently approved treatments for this indication. Antidepressants appear, however, to be effective, especially those with an action on noradrenergic neurotransmission. The objective of the present study was to test the efficacy of the dual action noradrenaline and serotonin reuptake inhibitor antidepressant, milnacipran, in the treatment of fibromyalgia. The 125 patients, who were enrolled in a double-blind, placebo-controlled, flexible dose escalation trial, were randomized to receive placebo or milnacipran for 4 weeks of dose escalation (up to 200 mg/day), followed by 8 weeks at a constant dose. The study evaluated the efficacy and safety of milnacipran for the treatment of pain and associated symptoms such as fatigue, depressed mood and sleep. 75% of milnacipran-treated patients reported overall improvement, compared with 38% in the placebo group (p < 0.01). Furthermore, 37% of twice daily milnacipran-treated patients reported at least 50% reduction in pain intensity, compared with 14% of placebo-treated patients (p < 0.05). 84% of all milnacipran patients escalated to the highest dose (200 mg/day) with no tolerability issues. Most adverse events were mild to moderate in intensity, and transient in duration. These results suggest that milnacipran may have the potential to relieve not only pain but several of the other symptoms associated with fibromyalgia.

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“…Pharmacologic interventions alone may benefit less than 50% of FM patients (Leventhal, 1999). In addition, drug hypersensitivity and adverse reactions to medications are not uncommon in these patients.…”

Section: Treatmentmentioning

confidence: 99%

Chronic fatigue syndrome and fibromyalgia: Clinical assessment and treatment

Friedberg

Jason

2001

J Clin Psychol

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Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are closely related illnesses of uncertain etiology. This article reviews the research literature on these biobehavioral conditions, with an emphasis on explanatory models, clinical evaluation of comorbid psychiatric disorders, assessment of stress factors, pharmacologic and alternative therapies, and cognitive-behavioral treatment studies. Furthermore, clinical protocols suitable for professional practice are presented based on an integration of the authors' clinical observations with published data. The article concludes with the recognition that mental health professionals can offer substantial help to these patients.

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Management of Fibromyalgia

Cited by 91 publications

References 59 publications

Relationship between stress and pain in work‐related upper extremity disorders: The hidden role of chronic multisymptom illnesses*

Relationship between stress and pain in work‐related upper extremity disorders: The hidden role of chronic multisymptom illnesses*

A double-blind placebo-controlled trial of milnacipran in the treatment of fibromyalgia

Chronic fatigue syndrome and fibromyalgia: Clinical assessment and treatment

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