Fibromyalgia - New Treatments

Fibromyalgia (FM or FMS) is a condition that causes chronic musculoskeletal pain. In addition to widespread pain it is characterized by tender points, painful areas located in certain parts of the body. There are other symptoms, such as fatigue, headache, cognitive problems, sleep disorders, anxiety and depression.

People with fibromyalgia often have other comorbid diseases, such as chronic fatigue syndrome / myalgic encephalomyelitis (CFS / ME), migraines, restless leg syndrome (RLS) and irritable bowel syndrome (IBS). Fibromyalgia is commonly associated with autoimmune diseases, especially rheumatoid arthritis and lupus (SLE), but it is not considered an autoimmune disease. The exact mechanism that causes the disease is not fully understood.

Lyrica Dan Cymbalta

The FDA approved two drugs for fibromyalgia: pregabalin (Lyrica) in June 2007 and duloxetine (Cymbalta) in June 2008. Pregabalin is an anticancer drug (epilepsy), although it is often used for pain disorders. Duloxetine is an antidepressant SNRI (serotonin and norepinephrine reuptake inhibitor), also used for diabetic neuropathy and stress incontinence.

Although there are completely different classes of drugs, both Lyrica and Cymbalta can help with pain, sleep problems, fatigue, cognitive impairment, depression and anxiety caused by fibromyalgia, although they may not help everyone and even if you benefit, you may not. to improve on all the symptoms listed.

Other Similar Drugs

The drug companies behind this drug certainly seem like we believe they are magic bullets, but luckily there are many other drugs that can help with fibromyalgia. Manufacturers of most other medicines simply do not invest in the expensive trial required to obtain FDA approval - often because patents will expire soon and their benefits will fall dramatically.

For example, gabapentin (Neurontin) is an anticonvulsant very similar to Lyrica, which is widely used for fibromyalgia, but now Lyrica has surpassed it. These medicines have a very similar mode of action. There is no clear evidence that someone is more effective. Some people may tolerate pregabalin but not gabapentin, and vice versa. Neurontin comes with a lower price tag.

Duloxetine is not the only cause of SNRI antidepressants. Venlafaxine (Effexor) is also a SNRI, although at low doses it has little effect on norepinephrine. Milnacipran (Ixel) is a promising SNRI antidepressant that is not yet available in the United States, but is sold in most of Europe. It has shown good results in early fibromyalgia trial. It is also very cheap and is considered one of the best antidepressants available.

Anticonvulsants And Antidepressants

In general almost all anticonvulsants, including older names such as carbamazepine and lamotrigine and newer players like topiramate, zonisamide and levetiracetam may help with fibromyalgia symptoms. There is a huge difference in the mode of action among the drugs in this class, so even if one does not work or produces intolerable side effects, another may be worth trying. They tend to be very helpful for pain, mood problems and migraine prevention, often for sleeping.

The same goes for antidepressants. Because they are used in fibromyalgia not as fibromyalgia is a psychiatric disorder, but they are also used in many painful conditions such as migraine, chronic headache, neuropathic pain and IBS. It is thought that fibromyalgia may be associated with serotonin and norepinephrine deficiencies.

SSRI antidepressants such as fluoxetine (Prozac) are generally not very effective for pain. However, many other antidepressants also affect norepinephrine. These include tricyclic antidepressants such as amitriptyline (Elavil) and imipramine which have been used to treat fibromyalgia since the 1980s. They are used in very small doses, usually smaller than those used for depression. They are very effective at sleeping, but often cause too many side effects.

Opposition NMDA

The third class of promising drugs is the NMDA receptor antagonist. NMDA receptors are considered to be highly active in fibromyalgia and weight reduction which can relieve all symptoms of the condition. NMDA antagonists include dextromethorphan cough suppressant, amantadine used for influenza and Parkinson's disease, Alzheimer's drug memantine and riluzole, a new drug used for amyotrophic lateral sclerosis (ALS).

Other drugs that also isolate NMDA receptors include, for example. calcium channel blockers, many anticonvulsants, some opioids (methadone and dextropropoxyphene) and dantrolene and orphenadrine muscle charms. Magnesium and taurine amino acids may also have this effect.

Hormone Treatment

Fibromyalgia is also associated with endocrinological deficiencies (hormones), especially growth hormones, thyroid hormones and vitamin D, which are now considered steroid hormones. Others, such as estrogen, testosterone and cortisol are also suggested as causes.

Growth hormones have been shown to be deficient in a subset of people with fibromyalgia and supplements help many people. Unfortunately the treatment needs to be given as an injection and very expensive. Good luck with oral medications can also stimulate the growth hormone secretion, such as anti-anxiety drug buspirone, blood pressure medicine clonidine and muscle relaxant baclofen. Melatonin may also have this effect.

Some doctors believe that thyroid supplements can also relieve fibromyalgia symptoms in some cases where lab decisions should be normal. On the contrary, many patients have reported excellent results, despite relieving the pain of complete doses of large doses of vitamin D.

Favorite Drug Candidates

Many medicines are in clinical trial for fibromyalgia. Sodium oxybate (Xyrem) is a sleep aid that can also help with depression and pain. It is currently approved for narcolepsy, but is used off-label for severe insomnia. Some tests have shown good efficacy in fibromyalgia, but insurance companies may be struggling with price.

Flupirtine (Katadolon) is used in many European countries for example. low back pain. It has several properties that inhibit NMDA and has shown good efficacy in early trials. If the clinical trial is successful, the company plans to market it for fibromyalgia under the name Effirma.

Lacosamide (Vimpat) is an anticonvulsant with a novel action. It is not yet on the market, but may be approved in the US and Europe before the end of 2008. A recent phase IIa trial concluded that it was effective and well tolerated in fibromyalgia.

Low dose naltrexone (LDN) is a treatment that increases the secretion of endorphins, a natural painkiller. Fibromyalgia may be associated with endorphin deficiency, which may also contribute to fatigue, depression and other symptoms. Clinical trials trying LDN for fibromyalgia are currently underway in the United States.

Fibromyalgia - New Treatments


==========================