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Fibromyalgia Syndrome's New Paradigm: Neural Sensitization and Its Implications for Treatment

  [ 270 votes ]   [ 3 Comments ]
By Richard N. Podell, MD • • August 16, 2007

Objectives: To provide Fibromyalgia syndrome [FMS] specialists with an overview of information suitable for the education of primary care physicians about current understanding of the mechanism of and treatments for FMS.

Findings: Controlled studies using functional magnetic resonance imaging and other objective markers document FMS as a disorder of increased sensitivity of the central nervous system's pain signaling pathways. This "neural sensitization" model shifts the focus for treatment toward drugs that affect neural pathways.

New options include:

  • 5-hydroxytryptamine serotonin receptor antagonists such as odansetron [Zofran],
  • N-methyl-D-aspartate receptor antagonists such as Ketamine,
  • Growth hormone stimulants such as pyridostigmine [Mestinon],
  • Anti-seizure drugs such as gapapentin [Neurontin] or pregabalin [Lyrica],
  • Gamma hydroxy butyrate-related agonists such as sodium sodium oxybate [Xyrem],
  • And the new serotonin-norepinephrine reuptake inhibitors-class antidepressants such as duloxetine [Cymbalta] and milnacipran.

Also recommended is appropriately graded exercise, i.e., conditioning, work on sleep quality, and cognitive behavioral therapy to support coping skills.

Conclusion: Improved understanding of the neural mechanisms involved in FMS and new options for treatment make it imperative that FMS specialists reach out to educate their primary care physician colleagues.

Source: Journal of Musculoskeletal Pain, Volume: 15 Issue: 2, Page Range: 45 – 54 , DOI: 10.1300/J094v15n02_08, by Podell RN. UMDNJ-Robert Wood Johnson Medical School.

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Article Comments Post a Comment

New Paradigm
Posted by: bearcat
Aug 22, 2007
Finally we are getting some substantive research that demonstrates the true source of our pain! Although not delineating the etiology it nevertheless serves to validate our pain. I am on three of the newly advised medications (gabapentin,xyrem and cymbalta) and although not cured am so very much better. I am increasingly hopeful as I see research move away from female hysteria approaches to looking at what's going on in our neural systems and brains.
Reply Reply

Glad to hear your
Posted by: angelstapleton
Sep 8, 2007
I was glad to hear your doing good. I been sick for about 2 years and have just started to see new Dr. I am hoping to find one that will get me on the right track to aleast feeling better 50% of the time. I live in Mount vernon Mo . So if you know of any please let me know. Thanks Bless you you for your info . Angel


Posted by: applepansy
May 30, 2009
what side effects are you dealing with? thanks
Reply Reply
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