Those suffering with fibromyalgia deal with pain, fatigue, sleeplessness and emotional issues on a day-to-day basis. Fibromyalgia is a chronic disease requiring medication daily for sufferers to reach some level of quality in their lives. The goal of medication in fibromyalgia aims to reduce pain, stiffness, fatigue, disrupted sleep and mood symptoms.
Serotonin and Norepinephrine Reuptake Inhibitor
Individuals with fibromyalgia exhibit a state of heightened pain and sensory processing in the brain. The sensory circuit called the descending serotonergic-noradrenergic pathways processes pain out to all areas of the body. According to Philip Mease, M.D. in a December 2009 article in the "American Journal of Medicine," fibromyalgia sufferers possess disturbances and decreases in these neurotransmitters that process the pain information. The drugs, duloxetine and milnacipran increase both norepinephrine and serotonin transmission to decrease pain. Duloxetine improves mood and decreases depression as well.
Anticonvulsants
Siegfried Kasper in a June 2009 article in "Human Psychopharmacology" describes the two drugs, pregabalin and gabapentin moderating the release of the neurotransmitters glutamate and substance P as part of the sensory pain process. Both pain and fatigue reduction occurred in the patients using this type of drug. Pregabalin became the first drug marketed specifically for fibromyalgia.
Hypnotic Medicine
Individuals with fibromyalgia complain of poor quality sleep and insomnia. Laurence Bradley, Ph.D. in the December 2009 issue of the "American Journal of Medicine" reports that the sleep disturbances arise from enhanced pain and the sleep impairment inhibits the healing of muscle tissue damage. The nonbenzodiazepine sedatives of zolpidem and zopiclone promote restful sleep in fibromyalgia. The newer drug, sodium oxybate, failed to pass the Food and Drug Administration approval on August 20, 2010, but patients involved with the research report that the new drug adds a much needed alternative to the other drugs and will be passed once safety warnings are addressed.
Dopamine D3 Receptor Agonists
According to Leslie Arnold, M.D. in the December 2009 issue of the "American Journal of Medicine," the drug, pramipexole exerts an effect on the dopamine neurotransmitters. The drug reduces arousal and sleep. Patients in a randomized study showed improvement on pain, fatigue and function in fibromyalgia. The long-term effect of this drug has not been studied.
Pain Medication
The use of opiate pain drugs like morphine or oxycodone continues to be controversial due to the potential for abuse. Leslie Arnold, M.D. in the December 2009 issue of the "American Journal of Medicine" describes recent studies that indicate the use of opiates actually increases the pain when used for prolonged periods. A novel pain medication, tramadol, shows analgesic properties as well as serotonin and norepinephrine reuptake inhibition like duloxetine. Patients showed even greater improvement of their pain symptoms with a combination tablet of tramadol and acetaminophen.
References
- "The American Journal of Medicine"; Further Strategies for Treating Fibromyalgia; Philip Mease, M.D.; 2009
- "Human Psychopharmacology"; The Psychiatrist Confronted with a Fibromyalgia Patient; Siegfried Kasper; 2009
- "The American Journal of Medicine"; Pathophysiology of Fibromyalgia; Laurence Bradley, Ph.D.; 2009
- Food and Drug Administration: Sodium Oxybate Oral Solution
- "The American Journal of Medicine"; Strategies for Managing Fibromyalgia; Leslie Arnold, M.D.; 2009
