The current treatment of fibromyalgia

José Oswaldo de Oliveira Júnior; Mauro Brito de Almeida

doi:10.5935/2595-0118.20180049

Review Article

The current treatment of fibromyalgia

O tratamento atual da fibromialgia

José Oswaldo de Oliveira Júnior; Mauro Brito de Almeida

http://dx.doi.org/10.5935/2595-0118.20180049 BrJP, vol.1, n3, p.255-262, 2018

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Abstract

BACKGROUND AND OBJECTIVES: Fibromyalgia is a highly relevant theme for research considering its impressive 2% worldwide prevalence, diffuse pain and suffering, largely unknown pathophysiology, scarce odds of cure and, more often than not, poor symptom control. This study aims to review the main options of treatment for fibromyalgia, including some novel alternatives.

CONTENTS: The pharmacological treatment for fibromyalgia can be prescribed in monotherapy or combination of drugs, which comprises antidepressants, muscle relaxants, anticonvulsants, cannabinoids, opioids, N-methyl D-Aspartate antagonists, melatoninergic agonists, peptidergic substances among others. Non-pharmacological therapies include acupuncture, behavioral (or psychobehavioral) and psychological (or psychotherapy) interventions, physical activity programs, hyperbaric oxygen therapy, ozone therapy, transcranial magnetic stimulation, stretching exercises associated to low intravenous curare doses, among others. Treatment modalities are presented according to possible mechanisms of action, level of scientific evidence and recommendation.

CONCLUSION: Fibromyalgia therapy should be individualized, and it does not aim the cure. Its objective is to reduce the subject’s suffering; provide function improvement and, as much as possible, the individual’s autonomy and quality of life. There is much in common in most approach recommendations, yet there are some divergence and changes as knowledge is acquired about a theme where consensus is far from being achieved.

Keywords

Amytriptiline, Behavioral therapy, Duloxetine, Fibromyalgia, Physical activity programs, Pregabalin, Treatment

Resumo

JUSTIFICATIVA E OBJETIVOS: A impressionante prevalência de 2% da fibromialgia na população mundial, associada ao sofrimento a ela atribuída, à sua fisiopatologia ainda não integralmente desvendada, ao prognóstico reservado em relação à possibilidade de cura, e, aos resultados insatisfatórios no controle de seus sintomas, mormente os dolorosos; fazem dela um tema preferencial para investigação e estudo. O objetivo deste estudo foi apresentar uma revisão sobre os principais tratamentos sugeridos para os portadores de fibromialgia, incluindo alguns emergentes.

CONTEÚDO: O tratamento farmacológico da fibromialgia pode ser aplicado em monoterapia ou combinar fármacos, inclusive antidepressivos, relaxantes musculares, anticonvulsivantes, canabinoides, opioides, antagonistas N-metil D-Aspartato, agonistas melatoninérgicos, substâncias peptidérgicas entre outras. Os tratamentos classificados como não farmacológicos incluem a acupuntura, intervenções comportamentais (ou psicocomportamentais), psicológicas (ou psicoterápicas), programas de atividade física, oxigenoterapia hiperbárica, ozonioterapia, estimulação magnética transcraniana, relaxamento muscular com baixas doses de curare por via venosa associado a alongamento e realongamento, entre outros. Os tratamentos são apresentados e situados em relação aos respectivos possíveis mecanismos de ação, evidência científica e graus de recomendação.

CONCLUSÃO: O tratamento da fibromialgia é individualizado, e, não propõe sua cura. O objetivo é a redução do sofrimento de seus portadores, a melhora da funcionalidade, e na medida do possível, da autonomia pessoal e da qualidade de vida. A maioria das condutas e recomendações possuem muito em comum, porém não são totalmente congruentes, mostram dinamismo e mudanças à medida em que se acumula conhecimento sobre um assunto sobre o qual o consenso ainda está muito longe de ocorrer.

Palavras-chave

Amitriptilina, Duloxetina, Fibromialgia, Pregabalina, Programas de atividade física, Terapia psicocomportamental, Tratamento

References

Goldenberg DL. Fibromyalgia syndrome. An emerging but controversial condition. JAMA. 1987;257(20):2782-7.

Hauser W, Ablin J, Fitzcharles MA, Littlejohn G, Luciano JV, Usui C. Fibromyalgia. Nat Rev Dis Primers. 2015;1:15022.

Oliveira Junior JO. Dor Oncológica. Acta Oncol Bras. 1994;14(1):11-5.

Skaer TL. Fibromyalgia: disease synopsis, medication cost effectiveness and economic burden. Pharmacoeconomics. 2014;32(5):457-66.

Podolecki T, Podolecki A, Hrycek A. Fibromyalgia: pathogenetic, diagnostic and therapeutic concerns. Pol Arch Med Wewn. 2009;119(3):157-61.

Gerardi MC, Batticciotto A, Talotta R, Franco M Di, Atzeni F, Sarzi-Puttini P. Novel pharmaceutical options for treating fibromyalgia. Expert Rev Clin Pharmacol. 2016:1-7.

Kia S, Choy E. Update on Treatment Guideline in Fibromyalgia Syndrome with Focus on Pharmacology. Biomedicines. 2017;5(2):20.

Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choiniere M. Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Res Manag. 2013;18(3):119-26.

Bennett RM, Gatter RA, Campbell SM, Andrews RP, Clark SR, Scarola JA. A comparison of cyclobenzaprine and placebo in the management of fibrositis. A double-blind controlled study. Arthritis Rheum. 1988;31(12):1535-42.

Tofferi JK, Jackson JL, O'Malley PG. Treatment of fibromyalgia with cyclobenzaprine: a meta-analysis. Arthritis Rheum. 2004;51(1):9-13.

Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Hauser W, Fluss E. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-28.

Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014:CD007115.

Walitt B, Urrutia G, Nishishinya MB, Cantrell SE, Hauser W. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst Rev. 2015:CD011735.

Carville SF, Arendt-Nielsen L, Bliddal H, Blotman F, Branco JC, Buskila D. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008;67(4):536-41.

Arnold LM, Clauw DJ, Wohlreich MM, Wang F, Ahl J, Gaynor PJ. Efficacy of duloxetine in patients with fibromyalgia: pooled analysis of 4 placebo-controlled clinical trials. Prim Care Companion J Clin Psychiatry. 2009;11(5):237-44.

Arnold LM, Gendreau RM, Palmer RH, Gendreau JF, Wang Y. Efficacy and safety of milnacipran 100 mg/day in patients with fibromyalgia: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2010;62(9):2745-56.

Arnold LM, Wang F, Ahl J, Gaynor PJ, Wohlreich MM. Improvement in multiple dimensions of fatigue in patients with fibromyalgia treated with duloxetine: secondary analysis of a randomized, placebo-controlled trial. Arthritis Res Ther. 2011;13(3):R86.

Clauw DJ, Mease P, Palmer RH, Gendreau RM, Wang Y. Milnacipran for the treatment of fibromyalgia in adults: a 15-week, multicenter, randomized, double-blind, placebo-controlled, multiple-dose clinical trial. Clin Ther. 2008;30(11):1988-2004.

Mease PJ, Clauw DJ, Gendreau RM, Rao SG, Kranzler J, Chen W. The efficacy and safety of milnacipran for treatment of fibromyalgia. a randomized, double-blind, placebo-controlled trial. J Rheumatol. 2009;36(2):398-409.

Vaishnavi SN, Nemeroff CB, Plott SJ, Rao SG, Kranzler J, Owens MJ. Milnacipran: a comparative analysis of human monoamine uptake and transporter binding affinity. Biol Psychiatry. 2004;55(3):320-2.

Prescribing information. 2014.

Prescribing Information. 2013.

Arnold LM, Choy E, Clauw DJ, Oka H, Whalen E, Semel D. An evidence-based review of pregabalin for the treatment of fibromyalgia. Curr Med Res Opin. 2018:1-13.

Tzellos TG, Toulis KA, Goulis DG, Papazisis G, Zampeli VA, Vakfari A. Gabapentin and pregabalin in the treatment of fibromyalgia: a systematic review and a meta-analysis. J Clin Pharm Ther. 2010;35(6):639-56.

Derry S, Cording M, Wiffen PJ, Law S, Phillips T, Moore RA. Pregabalin for pain in fibromyalgia in adults. Cochrane Database Syst Res. 2017;9:CD011790.

Fink K, Dooley DJ, Meder WP, Suman-Chauhan N, Duffy S, Clusmann H. Inhibition of neuronal Ca2+ influx by gabapentin and pregabalin in the human neocortex. Neuropharmacology. 2002;42(2):229-36.

Cooper TE, Derry S, Wiffen PJ, Moore RA. Gabapentin for fibromyalgia pain in adults. Cochrane Database Syst Rev. 2017;1:CD012188.

Busch JA. Pregabalin (CI-1008) multiple-dose pharmacokinetics and safety/tolerance in healthy volunteers. Pharm Sci. 1999;1(^sSuppl 4):2033.

Baidya DK, Agarwal A, Khanna P, Arora MK. Pregabalin in acute and chronic pain. J Anaesthesiol Clin Pharmacol. 2011;27(3):307-14.

Bockbrader HN. Pregabalin pharmacokinetics and safety in healthy volunteers: results from two phase 1 studies. Neurology. 2000;54(^sSuppl 3):421.

Su TZ, Feng MR, Weber ML. Mediation of highly concentrative uptake of pregabalin by L-type amino acid transport in Chinese hamster ovary and Caco-2 cells. J Pharmacol Exp Ther. 2005;313(3):1406-15.

Freynhagen R, Strojek K, Griesing T, Whalen E, Balkenohl M. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain. 2005;115(3):254-63.

Bryans JS, Wustrow DJ. 3-substituted GABA analogs with central nervous system activity: a review. Med Res Rev. 1999;19(2):149-77.

Lauria-Horner BA, Pohl RB. Pregabalin: a new anxiolytic. Expert Opin Investig Drugs. 2003;12(4):663-72.

Boomershine CS. Pregabalin for the management of fibromyalgia syndrome. J Pain Res. 2010;3:81-8.

Harris RE, Clauw DJ, Scott DJ, McLean SA, Gracely RH, Zubieta JK. Decreased central mu-opioid receptor availability in fibromyalgia. J Neurosci. 2007;27(37):10000-6.

Baraniuk JN, Whalen G, Cunningham J, Clauw DJ. Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain. BMC Musculoskelet Disord. 2004;5:48.

Lawson K. Emerging pharmacological strategies for the treatment of fibromyalgia. World J Pharmacology. 2017;6(1):1-10.

Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016;338:114-29.

Younger J, Noor N, McCue R, Mackey S. Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels. Arthritis Rheum. 2013;65(2):529-38.

Tsuda M, Masuda T, Tozaki-Saitoh H, Inoue K. Microglial regulation of neuropathic pain. J Pharmacol Sci. 2013;121(2):89-94.

Ngian GS, Guymer EK, Littlejohn GO. The use of opioids in fibromyalgia. Int J Rheum Dis. 2011;14(1):6-11.

Derry S, Wiffen PJ, Hauser W, Mucke M, Tolle TR, Bell RF. Oral nonsteroidal anti-inflammatory drugs for fibromyalgia in adults. Cochrane Database Syst Rev. 2017;3:CD012332.

Gould GG, Seillier A, Weiss G, Giuffrida A, Burke TF, Hensler JG. Acetaminophen differentially enhances social behavior and cortical cannabinoid levels in inbred mice. Prog Neuropsychopharmacol Biol Psychiatry. 2012;38(2):260-9.

Weber J, Schley M, Casutt M, Gerber H, Schuepfer G, Rukwied R. Tetrahydrocannabinol (Delta 9-THC) treatment in chronic central neuropathic pain and fibromyalgia patients: results of a multicenter survey. Anesthesiol Res Pract. 2009. 2009.

Skrabek RQ, Galimova L, Ethans K, Perry D. Nabilone for the treatment of pain in fibromyalgia. J Pain. 2008;9(2):164-73.

Ware MA, Fitzcharles MA, Joseph L, Shir Y. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesth Analg. 2010;110(2):604-10.

Being Studied in Fibromyalgia and Peripheral Neuropathic Pain. .

Banks S, O'Neill C, Sebreee T. Pharmacokinetic Evaluation of Subcutaneously Administered ZYN001 in Male Sprague-Dawley Rats. .

Walitt B, Klose P, Fitzcharles MA, Phillips T, Hauser W. Cannabinoids for fibromyalgia. Cochrane Database Syst Rev. 2016;7:CD011694.

Tafelski S, Hauser W, Schafer M. Efficacy, tolerability, and safety of cannabinoids for chemotherapy-induced nausea and vomiting--a systematic review of systematic reviews. Schmerz. 2016;30(1):14-24.

Farré M, Farré A, Fiz J, Torrens M. Cannabis Use in fibromyalgia. Handbook of Cannabis and Related Pathologies. 2017:158-67p.

Lawson K. Potential drug therapies for the treatment of fibromyalgia. Expert Opin Investig Drugs. 2016;25(9):1071-81.

Schumacher M, Pasvankas G. Topical capsaicin formulations in the management of neuropathic pain. Prog Drug Res. 2014;68:105-28.

Oliveira Junior J. Efeito analgésico periférico do tramadol em modelo de dor pós-operatória em ratos. 2015.

Casanueva B, Rodero B, Quintial C, Llorca J, Gonzalez-Gay MA. Short-term efficacy of topical capsaicin therapy in severely affected fibromyalgia patients. Rheumatol Int. 2013;33(10):2665-70.

Zhou HY, Chen SR, Pan HL. Targeting N-methyl-D-aspartate receptors for treatment of neuropathic pain. Expert Rev Clin Pharmacol. 2011;4(3):379-88.

Foerster BR, Nascimento TD, DeBoer M, Bender MA, Rice IC, Truong DQ. Excitatory and inhibitory brain metabolites as targets of motor cortex transcranial direct current stimulation therapy and predictors of its efficacy in fibromyalgia. Arthritis Rheumatol. 2015;67(2):576-81.

Harte SE, Clauw DJ, Napadow V, Harris RE. Pressure pain sensitivity and insular combined glutamate and glutamine (Glx) are associated with subsequent clinical response to sham but not traditional acupuncture in patients who have chronic pain. Med Acupunct. 2013;25(2):154-60.

Fayed N, Olivan-Blazquez B, Herrera-Mercadal P, Puebla-Guedea M, Perez-Yus MC, Andres E. Changes in metabolites after treatment with memantine in fibromyalgia. A double-blind randomized controlled trial with magnetic resonance spectroscopy with a 6-month follow-up. CNS Neurosci Ther. 2014;20(11):999-1007.

Lu KW, Hsieh CL, Yang J, Lin YW. Effects of electroacupuncture in a mouse model of fibromyalgia: role of N-methyl-D-aspartate receptors and related mechanisms. Acupunct Med. 2017;35(1):59-68.

Harris RE, Napadow V, Huggins JP, Pauer L, Kim J, Hampson J. Pregabalin rectifies aberrant brain chemistry, connectivity, and functional response in chronic pain patients. Anesthesiology. 2013;119(6):1453-64.

Srinivasan V, Pandi-Perumal SR, Spence DW, Moscovitch A, Trakht I, Brown GM. Potential use of melatonergic drugs in analgesia: mechanisms of action. Brain Res Bull. 2010;81(4-5):362-71.

Zanette SA de, Vercelino R, Laste G, Rozisky JR, Schwertner A, Machado CB. Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial. BMC Pharmacol Toxicol. 2014;15:40.

Hussain SA, Al II K, Jasim NA, Gorial FI. Adjuvant use of melatonin for treatment of fibromyalgia. J Pineal Res. 2011;50(3):267-71.

Bruno A, Mico U, Lorusso S, Cogliandro N, Pandolfo G, Caminiti M. Agomelatine in the treatment of fibromyalgia: a 12-week, open-label, uncontrolled preliminary study. J Clin Psychopharmacol. 2013;33(4):507-11.

Calandre EP, Slim M, Garcia-Leiva JM, Rodriguez-Lopez CM, Torres P, Rico-Villademoros F. Agomelatine for the treatment of patients with fibromyalgia and depressive symptomatology: an uncontrolled, 12-week, pilot study. Pharmacopsychiatry. 2014;47(2):67-72.

Turk DC, Adams LM. Using a biopsychosocial perspective in the treatment of fibromyalgia patients. Pain Manag. 2016;6(4):357-69.

Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev. 2013:CD007070.

Burnstock G. Purinergic nerves. Pharmacol Rev. 1972;24(3):509-81.

Burnstock G. Physiology and pathophysiology of purinergic neurotransmission. Physiol Rev. 2007;87(2):659-797.

Burnstock G. Acupuncture: a novel hypothesis for the involvement of purinergic signaling. Med Hypotheses. 2009;73(4):470-2.

Tang Y, Yin HY, Rubini P, Illes P. Acupuncture-induced analgesia: a neurobiological basis in purinergic signaling. Neuroscientist. 2016;22(6):563-78.

Nedergaard M. Enhancing the therapeutic effect of acupuncture with adenosine. .

Takano T, Chen X, Luo F, Fujita T, Ren Z, Goldman N. Traditional acupuncture triggers a local increase in adenosine in human subjects. J Pain. 2012;13(12):1215-23.

Perissinoti D. Psicologia Hospitalar. 2004.

Theadom A, Cropley M, Smith HE, Feigin VL, McPherson K. Mind and body therapy for fibromyalgia. Cochrane Database Syst Rev. 2015:CD001980.

Bernardy K, Klose P, Busch AJ, Choy EH, Hauser W. Cognitive behavioural therapies for fibromyalgia. Cochrane Database Syst Rev. 2013:CD009796.

Fordyce WE. Behavioral Concepts in Chronic Pain and Illness. 1976.

Thieme K, Gromnica-Ihle E, Flor H. Operant behavioral treatment of fibromyalgia: a controlled study. Arthritis Rheum. 2003;49(3):314-20.

Thieme K, Flor H, Turk DC. Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments. Arthritis Res Ther. 2006;8(4):R121.

Diers M, Yilmaz P, Rance M, Thieme K, Gracely RH, Rolko C. Treatment-related changes in brain activation in patients with fibromyalgia syndrome. Exp Brain Res. 2012;218(4):619-28.

Hassett AL, Williams DA. Non-pharmacological treatment of chronic widespread musculoskeletal pain. Best Pract Res Clin Rheumatol. 2011;25(2):299-309.

Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26(1):1-9.

Jensen KB, Kosek E, Wicksell R, Kemani M, Olsson G, Merle JV. Cognitive Behavioral Therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia. Pain. 2012;153(7):1495-503.

Frith C, Dolan RJ. Brain mechanisms associated with top-down processes in perception. Philos Trans R Soc Lond B Biol Sci. 1997;352(1358):1221-30.

Williams DA, Clauw DJ. Understanding fibromyalgia: lessons from the broader pain research community. J Pain. 2009;10(8):777-91.

Busch AJ, Webber SC, Brachaniec M, Bidonde J, Bello-Haas VD, Danyliw AD. Exercise therapy for fibromyalgia. Curr Pain Headache Rep. 2011;15(5):358-67.

Naumann J, Sadaghiani C. Therapeutic benefit of balneotherapy and hydrotherapy in the management of fibromyalgia syndrome: a qualitative systematic review and meta-analysis of randomized controlled trials. Arthritis Res Ther. 2014;16(4):R141.

Efrati S, Fishlev G, Bechor Y, Volkov O, Bergan J, Kliakhandler K. Hyperbaric oxygen induces late neuroplasticity in post stroke patients-randomized, prospective trial. PLoS One. 2013;8(1).

Sutherland AM, Clarke HA, Katz J, Katznelson R. Hyperbaric oxygen therapy: a new treatment for chronic pain?. Pain Pract. 2016;16(5):620-8.

Rokitansky O. Clinical consideration and biochemistry of ozone therapy. Hospitalis. 1982;52:643-711.

Hidalgo-Tallon J, Menendez-Cepero S, Vilchez JS, Rodriguez-Lopez CM, Calandre EP. Ozone therapy as add-on treatment in fibromyalgia management by rectal insufflation: an open-label pilot study. J Altern Complement Med. 2013;19(3):238-42.

Wu X, Li Z, Liu X, Peng H, Huang Y, Luo G. Major ozonated autohemotherapy promotes the recovery of upper limb motor function in patients with acute cerebral infarction. Neural Regen Res. 2013;8(5):461-8.

Borrelli E, Bocci V. A novel therapeutic option for chronic fatigue syndrome and fibromyalgia. Rivista Italiana di Ossigeno-Ozonoterapia. 2002;1:149-53.

Efrati S, Golan H, Bechor Y, Faran Y, Daphna-Tekoah S, Sekler G. Hyperbaric oxygen therapy can diminish fibromyalgia syndrome--prospective clinical trial. PLoS One. 2015;10(5).

Hou WH, Wang TY, Kang JH. The effects of add-on non-invasive brain stimulation in fibromyalgia: a meta-analysis and meta-regression of randomized controlled trials. Rheumatology. 2016;55(8):1507-17.

Saltychev M, Laimi K. Effectiveness of repetitive transcranial magnetic stimulation in patients with fibromyalgia: a meta-analysis. Int J Rehabil Res. 2017;40(1):11-8.

Ablin JN, Amital H, Ehrenfeld M, Aloush V, Elkayam O, Langevitz P. [Guidelines for the diagnosis and treatment of the fibromyalgia syndrome]. Harefuah. 2013;152(12):742-7.

Oliveira Jr JO, Andrade MP, Carrocini D. Poster. 1996.

Submitted date:
05/23/2018

Accepted date:
07/18/2018

The current treatment of fibromyalgia

O tratamento atual da fibromialgia

José Oswaldo de Oliveira Júnior; Mauro Brito de Almeida

Abstract

Keywords

Resumo

Palavras-chave

References

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