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Acute and Chronic Pain Management in Fibromyalgia: Updates on Pharmacotherapy – Source: American Journal of Therapeutics, May 7 2010

  [ 39 votes ]   [ 2 Comments ]
By ES Hsu • • May 14, 2010

Fibromyalgia (FM) is a mysterious pain syndrome with progressive and widespread pain, explicit areas of tender points, stiffness, sleep disturbance, fatigue, and psychological distress without any obvious disease. FM is commonly perceived as a condition of central pain and sensory augmentation. There are documented functional abnormalities in pain and sensory processing in FM.

Central sensitization and lack of descending analgesic activity are the 2 leading mechanisms that have been demonstrated by advance in both basic and clinical research. The pathogenesis of FM may also be attributed to the genetic polymorphisms involving serotoninergic, dopaminergic, and catecholaminergic systems. Any psychiatric disorders and psychosocial influences in FM may also affect the severity of pain. The various external stimuli or trigger such as infection, trauma, and stress may all contribute to/proceed to presentation of FM.

The recent launches of 3 US Food and Drug Administration-approved pharmacotherapy for FM namely pregabalin, duloxetine, and milnacipran have certainly raised the profile of optimal chronic pain management.


• Appropriate evaluation and efficacious management of acute pain has not been as well publicized as chronic pain in FM.

• Acute pain or flare up caused by any trauma or surgery certainly may present a real challenge for patients with FM and their health care providers.

• Pre-emptive analgesia and pro-active treatment may offer the momentum for acute pain control based on model of central sensitization and pain in FM.

This review article on FM appraises the modern practice of multimodal therapy focus on both acute and chronic pain management.

Meanwhile, the evolving nonpharmacological approach is summarized and stressed as an essential component of integrated care in FM.

Source: American Journal of Therapeutics, May 7, 2010. PMID: 20458213, by Hsu ES. Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

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Article Comments Post a Comment

Should be persuing immunomodulation
Posted by: IanH
May 14, 2010
It seems so inadequate a process to treat Fibromyalgia with these drugs when the increased pain is most likely initiated at the immunological level. So for me modulating cytokines such as neurokinin-1, IL-1b, IL-6 etc would be a more appropriate way to tackle, not only the pain but also the other symptoms of FMS. There seems to be a lack of research into immunological level-pain management.
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Oxygenation at the Cellular level - the first gold standard for health in my humble opinion
Posted by: Rozmund
May 19, 2010
In my experience now of 15 years with painful FM - and now a caregiver myself for a Parkinson's spouse...I have found that Far Infra Red Heat Fir Dome and Chi Machine, created by HTE - reduces any inflammation I may create by using my body repetitiously which appears almost as abuse - and then following up with the passive CHI machine modulating exercise effect increasing Oxygen on the cellular level alleviating my pain in 15 minutes...enough so that I may carry on with my responsibilities....doing this several times a day...keeps me in good shape - to know that I can generate energy being a senior is a great stress reliever, and gives me the confidence to support my invalid spouse.

I was so blown away when I first tried these these Medical Devices for 10 days, that I learned as much about them as I could and then became a distributor...please feel free to visit my website: and click on the links - and learn....the CHI machine was even featured by a Chiropractic Doctor on The DoctorsTV show - totally save, non invasive, no travelling, no weather constraints, can be a family health adventure...good for ages 4 to 100....scientifically created...these medical devices have the approval of both US and Canadian Health Services...check it out. site is only the tip of the may ask how can a few machines assist in so many illnesses...the answer is simple... the common denominator through our entire body is "the cell" and these must be healthy in order to do their job...when they are sick, we are sick, when inflammation is removed from the body, daily, when the body is ionzied negatively daily to counteract our modern industrial wireless way of life, when our electrical systems are brought into balance, creating ATP the virtual furnace for cellular energy, when our 70 trillion cells are rejuvenated with oxygen so that we can properly convert the nutrients we take in, and properly expel what is needed , over time, a feel ing of well being, cognitive point of power and joy is derives a feeling of personal control...this spills over into other areas of life...

case in point...if the Chi Machine is used for 15 minutes each day - and that can be at one treatment point, or several throughout the day the oxygen intake is equivalent to a brisk walk for 1 hour and 15 minutes. Think about we have the time to take a brisk walk daily in every kind of weather in any air quality environment ...are we always up to every age level...we can still play our games of golf, tennis, hockey, baseball, etc..only better...because all systems are GO...I find that simply having the CHI machine and the Fir Dome next to my bed - is all I need - 15 minutes and I am done....

the list of doctors and scientists involved in the creation of these healing devices is your research, google it...or make it simple, contact me...but don't wait until a lifetime of poor health takes its preemptive...

again, in my humble opinion


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