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Pathogenetic aspects of responsiveness to ondansetron 5-hydroxytryptamine type 3 receptor antagonist) in patients with primary fibromyalgia (FM) syndrome--a preliminary study

  [ 72 votes ]   [ Discuss This Article ] • August 15, 1996

OBJECTIVE: To study the efficacy of 5-hydroxytryptamine type 3
receptor (5-HT-3R) antagonist (ondansetron) vs paracetamol in
primary fibromyalgia (FM) syndrome.

METHODS: A double blind,
crossover, latin square study of 21 patients with FM. Visual
analog scale (VAS) and body drawings were used to record pain
intensity. Functional symptoms were determined for using a
Likert-type self-developed protocol. Quantitative dolorimetry
was applied to assess the number of painful tender points and
the average pain threshold. Serum serotonin levels were
measured by a commercial ELISA.

RESULTS: A marked improvement
in pain intensity measured by VAS (p < 0.005), pain score (p
< 0.05), tender points (p < 0.05), and average pain threshold
(p < 0.01) was obtained with ondansetron, whereas no
improvement was seen with paracetamol. After ondansetron
treatment, there was also significant reduction in both
functional symptoms (p < 0.01) and headache intensity (p <
0.05). In patients who did not respond to ondansetron there
was higher baseline pain intensity measured by VAS (p < 0.05)
and pain score (p < 0.01), and a lower pain threshold (p <
0.05) compared to those who did respond well. In the
responsive group, no significant differences were seen in the
serotonin level before and after therapy. Whereas a
significant increase in serum serotonin concentration (p <
0.01) was observed in nonresponders after ondansetron

CONCLUSION: Ondansetron appears to be an effective
drug in about 50% of patients with FM. There may be 2 subsets
of patients with FM that differ clinically and
pathogenetically with regard to the disturbance in the
5-HT-3R system.

Hrycaj P, Stratz T, Mennet P, Muller W

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