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Medications

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Fibromyalgia

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Abstract

The medication management and pharmacologic treatment of a disease process is based on targeting the sites of action or dysfunction of the disease at chemical and cellular levels. The pathophysiology of fibromyalgia is not fully known or understood though there are some theories supported by research. One theory is that dysfunction of both serotonin and norepinephrine systems may play a major role in the disease process (Arnold LM, Rosen A, Pritchett YL, et al., Pain 2005;119(1–3):5–15). The reduction of these protective neurotransmitters in turn leads to dysfunction of the pain inhibitory mechanisms, commonly known as descending inhibition. This can lead to peripheral and central sensitization and persistent and heightened pain perception (Arnold LM, Rosen A, Pritchett YL, et al., Pain 2005;119(1–3):5–15). Antidepressant medications such as tricyclic antidepressants (TCA) and serotonin–norepinephrine reuptake inhibitors (SNRI) have been used to restore the balance and ultimately reduce pain and disability.

Other potential mechanisms at work in this syndrome could be downregulation of mu-opioid receptors or elevated levels of endogenous opioids. This would further explain why patients with fibromyalgia are poor responders to opioids. Not only are opioids not shown to be effective in fibromyalgia but they also have many adverse effects including the potential for opioid-induced hyperalgesia.

Research has also demonstrated abnormal concentration of substance P and other neurotransmitters in patients with fibromyalgia (Schmidt-Wilcke T, Clauw DJ. Pharmacol Therapeut. 2010;127:283–94). This may be why anticonvulsant medications, especially ones that bind to calcium channels, may also provide benefit as membrane stabilizers. There are many other classes of lesser-studied medications that in theory would also have benefit for patients with fibromyalgia.

Fibromyalgia and its associated symptoms have a profound effect on the quality of life of patients and their productivity. This chapter presents and describes the actions of medications used both on and off label for treatment of this syndrome. Keep in mind that this is a limited perspective of pharmacologic treatment of this disease. The ideal treatment approach for fibromyalgia is multimodal, incorporating multidisciplinary approach.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Columbia New York Presbyterian, 622 West 168th Street, PH 5, 10032, New York, NY, USA

    A. Morgan Kelly MD

  2. Department of Anesthesiology & Peri-Operative Medicine, Oregon Health and Science University, 3303 SW Bond Avenue, 97239, Portland, OR, USA

    Asst. Prof. Kimberly Mauer MD

Authors
  1. A. Morgan Kelly MD
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  2. Asst. Prof. Kimberly Mauer MD
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Correspondence to A. Morgan Kelly MD .

Editor information

Editors and Affiliations

  1. Voluntary Faculty, Department of Anesthesiology, Center for Pain Medicine, University of California San Diego,, Lexington, South Carolina, USA

    Erin Lawson, MD

  2. Professor of Clinical Anesthesiology,Chief, Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, La Jolla, California, USA

    Mark S. Wallace, MD

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© 2015 Springer International Publishing Switzerland

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Kelly, A., Mauer, K. (2015). Medications. In: Lawson, MD, E., Wallace, MD, M. (eds) Fibromyalgia. Springer, Cham. https://doi.org/10.1007/978-3-319-15820-4_7

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  • DOI: https://doi.org/10.1007/978-3-319-15820-4_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15819-8

  • Online ISBN: 978-3-319-15820-4

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