Fibromyalgia (FM or FMS ) is a disease that causes chronic musculoskeletal pain. In addition to widespread pain , which is characterized by tender points , painful in certain areas of the body parts . There are often other symptoms such as fatigue , headache , cognitive disorders, sleep disorders, anxiety and depression.
People with fibromyalgia often have other comorbidities such as chronic syndrome / myalgic encephalomyelitis ( CFS / ME ) fatigue, migraines , restless legs syndrome ( RLS) and irritable bowel syndrome (IBS ) . Fibromyalgia is often produced with autoimmune diseases , especially rheumatoid arthritis and lupus (SLE) , but is not considered as an autoimmune disease . The exact mechanism that causes the disease is not yet fully understood.
Lyrica and Cymbalta
The FDA has approved two drugs for fibromyalgia : pregabalin (Lyrica ) in June 2007 to duloxetine ( Cymbalta) in June 2008 Pregabalin is an anticonvulsant ( epilepsy drugs ), but is more often used for pain disorders . . Duloxetine is an antidepressant SSRIs (selective reuptake inhibitor of serotonin and norepinephrine ) , also used for diabetic neuropathy and incontinence.
Despite being completely different classes of drugs , Lyrica and Cymbalta both can help with pain , problems , fatigue , cognitive impairment , depression and anxiety caused by fibromyalgia , sleep if you do not contribute to any world , and even if you benefit , you might not get an improvement in all the above symptoms.
Other similar drugs
Pharmaceutical companies behind these drugs are , of course , as we believe are the magic formulas, but fortunately there are many other medicines that can help fibromyalgia. The manufacturers of most other drugs simply have not invested in expensive trials necessary to obtain FDA approval - often because the patent expires soon and after that its benefits will be considerably lower.
For example , gabapentin (Neurontin ) is an anticonvulsant Lyrica very similar , which used to be widely prescribed for fibromyalgia, but now surpassed Lyrica . Drugs have almost identical modes of action . There is no clear evidence that one is more effective. Some people can not tolerate pregabalin but not gabapentin , and vice versa. Neurontin comes with a slightly cheaper price.
Duloxetine is not the only SSRI antidepressant browser . Venlafaxine (Effexor ) is an SNRI , even in low doses, has little effect on norepinephrine . Milnacipran ( Ixel ) is a promising SNRI antidepressant that is not yet available in the U.S. But is sold in most of Europe. Good results were shown in the preliminary experiments of fibromyalgia. It is also very cheap and considered one of the better tolerated antidepressants.
Anticonvulsants and antidepressants
In general almost all anticonvulsants, including former names such as carbamazepine and lamotrigine and new players such as topiramate, zonisamide and levetiracetam can help the symptoms of fibromyalgia. There are large differences in the modes of action between the drugs in this class, even if you do not work or produce intolerable side effects , another may be worth trying . They tend to be particularly useful for pain, mood disorders and migraine prevention , often during sleep.
It's the same for antidepressants , too. Why are used in fibromyalgia is that fibromyalgia is a psychiatric disorder , but also used in many other painful conditions like migraines, chronic headaches, neuropathic pain and IBS . It is believed that fibromyalgia may be associated with a deficiency of serotonin and norepinephrine.
SSRI antidepressants such as fluoxetine (Prozac ) are generally not as effective for pain. Many other antidepressants , but also affect noradrenaline. These include tricyclic antidepressants such as amitriptyline (Elavil ) and imipramine have been used to treat fibromyalgia since 1980. Were used in very small doses , usually much smaller than that used for depression. They are particularly effective for sleep, but often cause side effects too.
NMDA antagonists
A third promising class of drugs are NMDA receptor antagonists . The NMDA receptor is thought to be overactive in fibromyalgia and downregulation , can alleviate the symptoms of the disease. NMDA antagonists include cough suppressant dextromethorphan , amantadine, used for flu and Parkinson's disease , drug riluzole and memantine for Alzheimer's, a new drug used for amyotrophic lateral sclerosis (ALS ) .
Other drugs that downregulate the NMDA receptor include , for example , blockers of calcium channels , many seizure , certain opioids ( methadone and propoxyphene ) and muscle relaxants orphenadrine and dantrolene . Amino acids taurine and magnesium may also have this effect .
Hormone treatments
Fibromyalgia has also been associated with endocrine (hormonal deficiencies) , including growth hormone , thyroid hormone and vitamin D , which is now considered a steroid hormone. Others, such as estrogen , testosterone and cortisol have also been suggested as culprits.
Growth hormone has been shown to be deficient in a subset of people with fibromyalgia and supplementation helps many people . Unfortunately, the treatment must be administered by injection and is very expensive. Fortunately some oral medications may also stimulate the secretion of growth hormone , such as anti-anxiety drug buspirone , clonidine blood pressure medicine and muscle relaxants baclofen. Melatonin may also have this effect .
Some doctors believe that thyroid supplements can even completely relieve symptoms of fibromyalgia in some cases where it is expected that the results of laboratory normal . Moreover, many patients have reported excellent results , including pain relief with high doses of vitamin D.
Promising drug candidates
Many drugs are currently in clinical trials of fibromyalgia. Sodium oxybate ( Xyrem) is a sleep aid , which can also help with depression and pain. Currently approved for narcolepsy , but is used off-label for severe insomnia. Several trials have shown good efficacy in fibromyalgia , but insurance companies may frown at this price.
Flupirtine ( Katadolon ) is used in many European countries, for example , pain in the lower back. You have NMDA blocking properties and showed good efficacy in preliminary tests . If clinical trials are successful , the company plans to market for fibromyalgia, with the brand name Effirma .
Lacosamide ( Vimpat ) is an anticonvulsant with a new mode of action. Still not in the market but you can be approved in the United States 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 , natural painkillers. Fibromyalgia can be associated with endorphin deficiency , which could also contribute to fatigue , depression and other symptoms. A clinical trial to test LDN for fibromyalgia is currently underway in the United States.
Maija Haavisto is a journalist , medical writer and author of the most comprehensive book published on treatments for chronic / myalgic encephalomyelitis syndrome, fibromyalgia and fatigue related disorders . "Redo broken puppet : Treatments for CFS / ME and FMS " offers more than 250 different medications that can be used to treat these debilitating diseases.
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