Therapy Insight: Fibromyalgia-a different type of pain needing a different type of treatment

Journal: Nature Clinical Practice Rheumatology. 2006 July;2(7):364-372. Authors and Affiliations: Dadabhoy D and Clauw DJ. University of Michigan, Ann Arbor, MI, USA: D Dadabhoy is a Clinical Lecturer in Rheumatology and DJ Clauw is a Professor of Medicine, the Director of the Chronic Pain and Fatigue Research Center and the Center for the Advancement of Clinical Research, and the Assistant Dean for Clinical and Translational Research. PMID: 16932722 In the past decade, we have made tremendous progress in our understanding of Fibromyalgia, which is now recognized as one of many “central” pain syndromes that are common in the general population. Specific genes that might confer an increased risk of developing fibromyalgia syndrome are beginning to be identified and the environment (in this case exposure to stressors) might also have a significant effect on triggering the expression of symptoms. After developing the syndrome, the hallmark aberration noted in individuals with fibromyalgia is augmented central pain processing. Insights from research suggest that fibromyalgia and related syndromes require a multimodal management program that is different from the standard used to treat peripheral pain (i.e. acute or inflammatory pain). Instead of the nonsteroidal anti-inflammatory drugs and opioids commonly used in the treatment of peripheral pain, the recommended drugs for central pain conditions are neuroactive compounds that downregulate sensory processing. The most efficacious compounds that are currently available include the tricyclic drugs and mixed reuptake inhibitors that simultaneously increase serotonin and norepinephrine concentrations in the central nervous system. Other compounds that increase levels of single monoamines (serotonin, norepinephrine or dopamine), and anticonvulsants also show efficacy in this condition. In addition to these pharmacologic therapies, which are useful in improving symptoms, nonpharmacologic therapies such as exercise and cognitive behavioral therapy are useful treatments for restoring function to an individual with Fibromyalgia.

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