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.