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Venlafaxine Alleviates Pain and Disability Associated with Fibromyalgia

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A DGReview of:”Venlafaxine treatment of fibromyalgia”

Annals of Pharmacotherapy

By Mary Beth Nierengarten

Pain and disability associated with fibromyalgia were alleviated in patients who were treated with the antidepressant venlafaxine, reports a study from Turkey.

Despite the unknown pathophysiology of fibromyalgia, the possible role played by central monoaminergic transmission suggests that antidepressants that act on multiple neurotransmitters may improve symptom control.

Kemal Sayar, MD and colleagues from Farabi Hospital, Trabzon, evaluated the efficacy of venlafaxine in 20 patients with fibromyalgia given a fixed-dose of venlafaxine (75 mg/d). Primary outcomes evaluated at 6 and 12 weeks of the study were clinical severity of disease (measured by Fibromyalgia Impact Questionnaire (FIQ)) and degree of pain (measured by the Visual Analog Scale (VAS)). Other scales used to measure an association between psychological distress and physical symptoms included the Beck Depression and Anxiety Inventories and the Hamilton Depression and Anxiety scales.

Of the 20 patients enrolled in the study, 5 discontinued treatment after 1 week of treatment because of treatment-related adverse effects. Of the remaining 15 patients, the mean duration of disease was 3.7 years, the mean age was 37.7 years, 14 were married, 9 did not have any current psychiatric disorder (3 of whom had a history of major depressive disorder), 5 had generalized anxiety disorder, and 1 had bipolar disorder.

No significant decrease in pain was noted at 6 weeks after treatment initiation, but a significant improvement in pain intensity (P = .0001) and disability caused by fibromyalgia (P = .0001) were found at 12 weeks. A significant decrease in anxiety and depression was also found at 12 weeks compared to baseline. Having a current or past psychiatric disorder was not associated with any difference in perceived pain scores, with no significant associations found between FIQ scores and anxiety and depression measures.

Several limitations of this study include its study design (i.e., open trial), lack of measurement of tender points, withdrawal of 5 patients due to treatment-associated adverse effects, and small sample size.

With these caveats, the authors conclude that venlafaxine is a promising treatment for alleviating symptoms of pain and disability associated with fibromyalgia that should be further evaluated in placebo-controlled, double-blinded studies.

Ann Pharmacother 2003;37:11:1561-5. “Venlafaxine treatment of fibromyalgia”

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