ReviewUpdate on Fibromyalgia Therapy
Section snippets
Tricyclic Agents
The tricyclic antidepressants were the first drugs to be intensively studied in fibromyalgia. Tricyclic antidepressants increase synaptic concentrations of both serotonin and norepinephrine in the central nervous system; increased availability of these neurotransmitters reduces pain signaling. Amitriptyline is the tricyclic antidepressant most extensively studied. Short-term studies indicate benefit in up to one third of patients13, 14, 15; if effective, benefit is usually evident within the
Nonpharmacological Interventions
A recent review by Goldenberg suggested “strong evidence for efficacy” for a variety of nonmedicinal interventions, including cardiovascular exercise, cognitive behavioral therapy, patient education in group format, and multidisciplinary therapy, as well as “moderate evidence for efficacy” for a number of other adjunctive treatments.3 In contrast to the Goldenberg review, 2 other systematic reviews came to less sanguine conclusions about the value of nonpharmacological interventions.
Complementary and Alternative Therapies for Fibromyalgia
Assessment of complementary and alternative approaches to fibromyalgia treatment is limited by a paucity of clinical trials, with the few completed trials sharing the drawbacks that afflict other fibromyalgia studies.
Meditation-based stress reduction showed benefit in one study that lacked a control group.58 Dehydroepiandrosterone provided no benefit in pain, fatigue, mood, or functional abilities.59 Melatonin has not been studied in a blinded fashion.60
Acupuncture is commonly tried by
Approach to The Patient with Fibromyalgia: Practice-Based Evidence in the Absence of Evidence-Based Practice
Despite a paucity of solid data in support of many fibromyalgia therapies, the physician caring for a fibromyalgia patient is confronted with an individual whose discomfort is significant, and whose need for melioration is unquestionable. A number of treatments have shown clinical benefit when compared with placebo (see Table), although frequently not in a majority of the patients studied. Indeed, the heterogeneity of fibromyalgia patients renders a “one-size-fits-all” approach unlikely to be
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