Fibromyalgia Treatment Update

Daniel S. Rooks

Disclosures

Curr Opin Rheumatol. 2007;19(2):111-117. 

In This Article

Abstract and Introduction

Purpose of Review: Fibromyalgia is a common chronic pain disorder characterized by complex symptomatology and few consistently effective treatments. The purpose of this review is to highlight the recent literature from April 2005 through September 2006 involving treatment options.
Recent Findings: Prior evidence suggests that medication and self-management approaches to care can improve symptoms, function and well-being in this patient population. Recent studies examining the efficacy of two serotonin and norepinephrine-reuptake inhibitors - duloxetine and milnacipran - and the anticonvulsant pregabalin are encouraging. Studies evaluating different forms of exercise continue to support the belief that increased physical activity is an essential component of any treatment plan for the patient with fibromyalgia. Three studies added to the understanding of treatment adherence. Finally, three studies evaluating the efficacy of acupuncture in the treatment of fibromyalgia showed conflicting results, but added to the knowledge needed for clinicians to have substantive conversations with patients.
Summary: Recent studies support the recommendation of a multimodal approach to treatment involving individualized, evidence-based pharmacotherapy and self-management. Treatment goals should include the improvement of symptoms, primarily pain and sleep, and the promotion of positive health behaviors with the aim of improving physical function and emotional well-being.

Fibromyalgia is a common, multidimensional disorder with complex symptomatology and relatively poor treatment outcomes.[1,2**] Fibromyalgia is characterized by widespread pain for longer than 3 months and bilateral sites of amplified tenderness.[3] In most patients, fibromyalgia is associated with fatigue, sleep dysfunction, stiffness, depression, anxiety, cognitive disturbance, or exercise intolerance,[2**,3,4] and is reported to be more common in women and individuals with other rheumatic conditions.[5] The prevalence of fibromyalgia is estimated to be 2% in the USA[6,7*] and Canada.[8] The etiology and pathophysiology of fibromyalgia remain unclear. Current hypotheses center on atypical sensory processing in the central nervous system and dysfunction of skeletal muscle nociception and the hypothalamic-pituitary-adrenal axis.[9,10,11,12**]

Current treatments for fibromyalgia include medical, self-management and alternative interventions. The number of published studies, particularly randomized controlled trials, has risen steadily over the past decade. Treatment remains inadequate to reliably resolve persistent symptoms and improve functional limitations and quality of life in most patients. One reason for unsatisfactory outcomes may be the absence of an evidence-based standard of care. To address this void, a recent report commissioned by the American Pain Society provides a comprehensive assessment of the research supporting treatment choices for the patient with fibromyalgia and presents clinical practice guidelines, which are summarized in Table 1 .[1,13**] This paper will highlight studies evaluating treatment options for the patient with fibromyalgia published from April 2005 through September 2006.

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