Potential drug therapies for the treatment of fibromyalgia

Lawson, Kim

doi:10.1080/13543784.2016.1197906

Cited by 21 publications

(23 citation statements)

References 90 publications

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“…The relative contribution of each mechanism appears to vary between patients. This results in different responses to different drugs in different patients suggesting that the symptoms that characterize fibromyalgia need to be targeted through a number of different approaches [1]. …”

Section: Introductionmentioning

confidence: 99%

Modulation of NMDA Receptor Activity in Fibromyalgia

Littlejohn

Guymer

2017

Biomedicines

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Activation of the N-methyl-d-aspartate receptor (NMDAR) results in increased sensitivity of spinal cord and brain pathways that process sensory information, particularly those which relate to pain. The NMDAR shows increased activity in fibromyalgia and hence modulation of the NMDAR is a target for therapeutic intervention. A literature review of interventions impacting on the NMDAR shows a number of drugs to be active on the NMDAR mechanism in fibromyalgia patients, with variable clinical effects. Low-dose intravenous ketamine and oral memantine both show clinically useful benefit in fibromyalgia. However, consideration of side-effects, logistics and cost need to be factored into management decisions regarding use of these drugs in this clinical setting. Overall benefits with current NMDAR antagonists appear modest and there is a need for better strategy trials to clarify optimal dose schedules and to delineate potential longer–term adverse events. Further investigation of the role of the NMDAR in fibromyalgia and the effect of other molecules that modulate this receptor appear important to enhance treatment targets in fibromyalgia.

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Section: Introductionmentioning

confidence: 99%

Modulation of NMDA Receptor Activity in Fibromyalgia

Littlejohn

Guymer

2017

Biomedicines

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“…10,18,20 Varios estudios realizados con biopsias de piel en pacientes con FM demostraron disfunción mitocondrial por estrés oxidativo con posterior daño del nervio periférico; el 50% de los pacientes presentaron neuropatía periférica de fibras pequeñas. 18,21 En cuanto a las anomalías musculares se han identificado varias causas: incremento del consumo de oxígeno, bajo flujo sanguíneo, alto metabolismo e incremento de la inervación simpática; lo que conlleva a isquemia y acumulación de ácido láctico en el músculo, generando mialgias y fatiga. 19,[21][22][23] Otros autores han descrito, además, trastornos del sueño en polisomnografía en comparación con población sana, trastornos afectivos y déficit de melatonina.…”

Section: Etiopatogeniaunclassified

“…18,21 En cuanto a las anomalías musculares se han identificado varias causas: incremento del consumo de oxígeno, bajo flujo sanguíneo, alto metabolismo e incremento de la inervación simpática; lo que conlleva a isquemia y acumulación de ácido láctico en el músculo, generando mialgias y fatiga. 19,[21][22][23] Otros autores han descrito, además, trastornos del sueño en polisomnografía en comparación con población sana, trastornos afectivos y déficit de melatonina. 2,10,18 FISIOPATOLOGÍA A pesar del sinnúmero de investigaciones realizadas en FM, aún no está claro el proceso exacto por el cual se desencadena el dolor y la sensibilización 24 .…”

Section: Etiopatogeniaunclassified

“…2,10,17,24,25 Se han planteado diferentes hipótesis; sin embargo, en los últimos años las que mayor fuerza han tomado para explicar esta patología son: amplificación del dolor mediada por sensibilización central ante un proceso de nocicepción periférica constante, alteración de las vías descendentes inhibitorias del dolor y disfunción de receptores opioides en estas vías. 2,17,21,25 Así mismo, estudios han corroborado la presencia de un componente genético, que explica la predisposición familiar para FM. En estos, se ha documentado el compromiso de las vías serotoninérgicas, adrenérgicas, dopaminérgicas y de los genes que codifican para productos de trasporte, señalización, receptación y desactivación de los respectivos neurotransmisores, generando hipersensibilidad al dolor.…”

Section: Etiopatogeniaunclassified

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Visión desde la rehabilitación del paciente con fibromialgia

Árias

Varona

2017

Rev Col Med Fis Reh

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RESUMENLa fibromialgia (FM) es una de las causas más frecuentes de dolor crónico musculoesquelético difuso, no inflamatorio, no oncológico. Por lo general se encuentra asociada a trastornos afectivos como depresión y ansiedad, alteraciones del sueño, deterioro cognitivo y múltiples síntomas somáticos inespecíficos, que afectan la funcionalidad y la participación de los individuos en la esfera biopsicosocial, así como la calidad de vida. Por este motivo, es importante realizar, desde la visión de la rehabilitación, un abordaje integral del paciente con FM desde su diagnóstico, hasta su tratamiento, rehabilitación y seguimiento; brindar estrategias con las cuales se pueda disminuir y controlar al máximo la sintomatología, con el fin de mejorar la calidad de vida, la funcionalidad y la independencia de los pacientes. Palabras clave: fibromialgia, dolor crónico, rehabilitación, calidad de vida. DOI: 10.28957/rcmfr.v27n2a1 ABSTRACT Fibromyalgia (FM) is one of the most frequent causes of diffuse, non-inflammatory, nononcologic chronic musculoskeletal pain. It is usually associated with affective disorders such as depression, anxiety, sleep disturbances, cognitive impairment, and multiple nonspecific somatic symptoms that affect the functionality and participation of individuals in the biopsychosocial sphere, as well as quality of life. For this reason, it is important from the vision of rehabilitation to perform an integral approach of the patient with FM from its diagnosis, to its treatment, rehabilitation and follow-up; Provide strategies to reduce and control symptomatology to the maximum, in order to improve the quality of life, functionality and independence of patients.

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“…Fibromyalgia is a complex chronic condition characterized by widespread pain, physical fatigue, non-restorative sleep and cognitive impairment [1,2]. A high incidence of co-morbidities, such as depression, irritable bowel syndrome, headache and temporomandibular joint dysfunction, with variable intensity are reported [1,2].…”

Section: Introductionmentioning

confidence: 99%

A Brief Review of the Pharmacology of Amitriptyline and Clinical Outcomes in Treating Fibromyalgia

Lawson

2017

Biomedicines

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Fibromyalgia is a complex chronic condition characterized by pain, physical fatigue, sleep disorder and cognitive impairment. Evidence-based guidelines recommend antidepressants as treatments of fibromyalgia where tricyclics are often considered to have the greatest efficacy, with amitriptyline often being a first-line treatment. Amitriptyline evokes a preferential reduction in pain and fatigue of fibromyalgia, and in the Fibromyalgia Impact Questionnaire (FIQ) score, which is a quality of life assessment. The multimodal profile of the mechanisms of action of amitriptyline include monoamine reuptake inhibition, receptor modulation and ion channel modulation. Several of the actions of amitriptyline on multiple nociceptive and sensory processes at central and peripheral locations have the potential to act cumulatively to suppress the characteristic symptoms of fibromyalgia. Greater understanding of the role of these mechanisms of action of amitriptyline could provide further clues to the pathophysiology of fibromyalgia and to a preferable pharmacological profile for future drug development.

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Potential drug therapies for the treatment of fibromyalgia

Cited by 21 publications

References 90 publications

Modulation of NMDA Receptor Activity in Fibromyalgia

Modulation of NMDA Receptor Activity in Fibromyalgia

Visión desde la rehabilitación del paciente con fibromialgia

A Brief Review of the Pharmacology of Amitriptyline and Clinical Outcomes in Treating Fibromyalgia

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