Duloxetine and Pregabalin for Pain Management in Multiple Rheumatic Diseases Associated with Fibromyalgia

Abstract

The fibromyalgia syndrome (FMS) is characterized by chronic and widespread musculoskeletal pain and soreness accompanied by sleep disorders, chronic fatigue and affective disorders. FMS is often associated with other forms of immuno-rheumatic diseases. Although FMS pathophysiology is still not fully understood, a number of neuroendocrine, neurotransmission and neurosensitive disorders might generate a mechanism for the elicitation of pain by "central sensitization," which is common to many other painful conditions. The present case describes the success of a therapeutic scheme, which associates two different pharmacological classes, anticonvulsants and new-generation antidepressants, when FMS complicates a rare pathology called Cogan's syndrome. The association of two drugs might noticeably affect the molecular mechanisms of difficult pain, thus solving painful conditions of multifactorial origin.

Pathophysiologic Approach to Pain Therapy for Complex Pain Entities: A Narrative Review

“…An interesting study from Del Giorno et al [48] evaluated the therapeutic efficacy of duloxetine combined with pregabalin in patients suffering from fibromyalgia, and the possible added benefit of the lipid-signaling molecule PEA. The combination of duloxetine and pregabalin had previously been suggested [49], and was well documented to exert anti-inflammatory, analgesic, and pain-relieving effects in both preclinical and clinical studies. The authors concluded that adding PEA to an initial combination therapy of pregabalin plus duloxetine improved the outcome of fibromyalgia, and that when an additional medication is needed, PEA could serve as an optimal option [48].…”

Osteopathic manipulative treatment for an unusual presentation of fibromyalgia: A case report demonstrating the effectiveness of disease guidelines

“…The combination of duloxetine and pregabalin, an alpha-2-delta-binding neuromodulator, appears to be particularly beneficial for patients with difficulty sleeping. 2,15 Conclusion As stated earlier, fibromyalgia affects about 2% of the population, primarily women. Epidemiologic studies have shown the prevalence of fibromyalgia to be 2% overall, 1 with the prevalence being 3.4% in women and 0.5% in men.…”

“…Together, duloxetine and pregabalin show potential efficacy when associated with several chronic painful conditions. 2 The patient was satisfied with each aspect of her treatment. She was provided realistic information about the resolution of her symptoms and was educated on what could be done if she failed to achieve relief, including a more comprehensive thyroid hormone panel and a possible trial of levothyroxine or referral to an endocrinologist.…”

“…The differential diagnosis includes rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, hepatitis, hypothyroidism, diabetes mellitus, electrolyte imbalances, and many more disease entities. 2 For example, a single patient may simultaneously fulfill criteria for the diagnosis of both fibromyalgia and chronic fatigue syndrome. Diagnostic criteria are intended as guidelines for diagnosis, rather than steadfast requirements.…”

Comparative Efficacy of Newer Antidepressants in Combination with Pregabalin for Fibromyalgia Syndrome: A Controlled, Randomized Study

“…Furthermore, many individuals experience adverse events with SNRIs (nausea, dry mouth, constipation, headache, somnolence, dizziness, and insomnia), leading to termination of medication use . On the other hand, evidence from clinical studies shows that pregabalin in combination with SNRIs such as duloxetine can be beneficial for the treatment of pain, fatigue, and sleep disorders in fibromyalgia patients and that the combination is better tolerated than SNRIs alone …”