Therapy Insight: fibromyalgia—a different type of pain needing a different type of treatment

  title={Therapy Insight: fibromyalgia—a different type of pain needing a different type of treatment},
  author={Dina Dadabhoy and Daniel J. Clauw},
  journal={Nature Clinical Practice Rheumatology},
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… 
Fibromyalgia: presentation and management with a focus on pharmacological treatment.
Effective management of fibromyalgia is complex and requires a multidisciplinary treatment approach, and response and tolerance of different therapeutic interventions vary from patient to patient.
Chapter 33 – Fibromyalgia
Fibromyalgia: Should the treatment paradigm be monotherapy or combination pharmacotherapy?
Positive results of recent monotherapy trials of several norepinephrine and serotonin reuptake inhibitors are reviewed, outlining the basis for rational treatment using this approach in FM in order to most effectively treat multiple symptom domains.
Fibromyalgia Syndrome - a multidisciplinary approach.
FMS patients may also require help from the Psychiatric Clinic (Out-Patients Clinic) due to accompanying mental problems, and the pharmacological treatment options are limited and only complex therapy gives relatively good results.
Juvenile Fibromyalgia: A Primary Pain, or Pain Processing, Disorder.
Fibromyalgia: from pathophysiology to therapy
The roles of biological and psychological stress, genetic factors, and pain and sensory processing in the pathophysiology of fibromyalgia and related conditions are discussed and pharmacological treatments, as well as nonpharmacological treatment options are considered.
First pregabalin and now duloxetine for fibromyalgia syndrome: closer to a brave new world?
The lack of standardization in FMS trial design and controversy surrounding the disorder have complicated the development of integrated therapeutic regimens that could bring about a brave new world of effective management of FMS.
Acute pain management in patients with fibromyalgia and other diffuse chronic pain syndromes
The perioperative pain management of patients with fibromyalgia is challenging and should include symptom-based approaches to target enhanced central sensitization and decreased inhibition in these patients as well as their psychological syndromes aiming to decrease acute and prolonged pain after surgery.


Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors.
There appears to be a group of fibromyalgia patients who exhibit extreme tenderness but lack any associated psychological/cognitive factors, an intermediate group who display moderate tenderness and have normal mood, and a group in whom mood and cognitive factors may be significantly influencing the symptom report.
Neurobiology of fibromyalgia syndrome.
Evidence for abnormal sensitization mechanisms in FM includes enhanced temporal summation of delayed pain in response to repeated heat taps and repeated muscle taps, as well as prolonged and enhanced painful after-sensations in FM patients but not control subjects.
Efficacy of milnacipran in patients with fibromyalgia.
In this Phase II study, milnacipran led to statistically significant improvements in pain and other symptoms of FM, the effect sizes were equal to those previously found with TCA, and the drug was generally well tolerated.
Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial.
Pregabalin at 450 mg/day was efficacious for the treatment of FMS, reducing symptoms of pain, disturbed sleep, and fatigue compared with placebo and was well tolerated and improved global measures and health-related quality of life.
Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms.
Various components of the central nervous system appear to be involved, including the hypothalamic pituitary axes, pain-processing pathways, and autonomic nervous system, which lead to corresponding changes in immune function, which are postulate are epiphenomena rather than the cause of the illnesses.
Antidepressant treatment of fibromyalgia. A meta-analysis and review.
Fibromyalgia is a common musculoskeletal pain disorder associated with mood disorders. Antidepressants, particularly tricyclics, are commonly recommended treatments. Randomized, controlled trials of
Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder.
Preliminary evidence is provided that patients with CFS, FM, and TMD share key symptoms, and it also is apparent that other localized and systemic conditions may frequently co-occur with C FS,FM, andTMD.
Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms.
Investigating relationships between sex, pain threshold and fibromyalgia (FM) symptoms in the general population suggests that decreased pain threshold, as measured by the tender point counts, is an intrinsically important aspect of patient distress, regardless of the extent and kind of concomitant disease.