Treatment of fibromyalgia with antidepressants

O’Malley, Patrick G.; Balden, Erin; Tomkins, Glen; Santoro, James; Kroenke, Kurt; Jackson, Jeffrey L.

doi:10.1046/j.1525-1497.2000.06279.x

Cited by 304 publications

(136 citation statements)

References 47 publications

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“…Cardinal symptoms of FM are widespread body pain and a minimum of 11 out of 18 tender points evident for at least 3 months (1). One stream of research has focused on single modality treatments for FM such as medications (2,3) or exercise (4 -6). Although pessimism prevails with regard to prognosis (7,8), a consensus has emerged that exercise is one critical component of treatment for patients with FM (9).…”

Section: Introductionmentioning

confidence: 99%

Maintenance of exercise in women with fibromyalgia

Dobkin¹,

Abrahamowicz²,

Fitzcharles³

et al. 2005

Arthritis & Rheumatism

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Objective. To identify predictors of maintenance of exercise for women with fibromyalgia (FM).Methods. Women with FM who had been randomized to the exercise arm of a clinical trial were studied prospectively during and 3 months following treatment. Subjects completed exercise logs weekly and returned the data via postal mail. Outcome variables were duration of aerobic and stretching exercises. Two separate multivariate models for longitudinal data were built with adjustment for in-treatment adherence and time. Pretreatment characteristics (self efficacy, pain, disability, stress, exercise barriers and benefits, and age) and changes during treatment (pain, disability, stress, and exercise barriers and benefits) were considered potential predictors of exercise maintenance. Results. Stretching significantly decreased in the 3 months following treatment. High stress at baseline and increases in stress during treatment were associated with poor maintenance of stretching. Disability at baseline (measured with the Fibromyalgia Impact Questionnaire), an increase in barriers to exercise during treatment, and increases in upper-body pain during treatment were associated with worse maintenance of aerobic exercise in the 3 months following treatment. Conclusion. The maintenance of an exercise program in women with FM appears to be contingent on being able to deal with stress, pain, barriers to exercise, and disability.

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Section: Introductionmentioning

confidence: 99%

Maintenance of exercise in women with fibromyalgia

Dobkin¹,

Abrahamowicz²,

Fitzcharles³

et al. 2005

Arthritis & Rheumatism

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“…Antidepressants have an antinociceptive effect on various forms of pain but none of the antidepressant drugs, have yet been approved by the FDA for the treatment of FM (10)(11)(12)(13)(14). The recent meta-analyses of antidepressant trials have shown that tricyclic antidepressants to be moderately effective in the treatment of patients with FM (7,15). Although the studies evaluating the effects of selective serotonin reuptake inhibitors (SSRIs) in the treatment of FM yielded inconsistent results, these medications are better tolerated than the tricyclic antidepressants (16,17).…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Reboxetine and Amitryptilline in the Treatment of Fibromyalgia Syndrome with Co-morbid Depressive Symptoms: An Open-label Preliminary Study

Konuk

Ortancil

Bostanci

et al. 2010

Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychophar

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“…In a meta-analysis, O'Malley et al (12) found that benefits were mild for fatigue and moderate for sleep, overall well-being, and pain severity. The measure least likely to improve was tenderness.…”

Section: Modulation Of Monoamines In Fmsmentioning

confidence: 99%

Balanced treatments for fibromyalgia

Littlejohn

2004

Arthritis & Rheumatism

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It has been more than 25 years since Smythe and Moldofsky refocused attention on the fibromyalgia syndrome (FMS) (1). Their observations clearly characterized the predictable clinical features of this common pain syndrome and initiated new enquiry into an enigmatic disorder. The core characteristic of widespread pain was seen to occur in conjunction with the presence of widespread tenderness, implying complex changes to the neurophysiologic activities of the pain system. Smythe and Moldofsky emphasized the intimate link between the "physical" symptoms and signs of fibromyalgia, on the one hand, and the presence of a number of personal and emotional factors, on the other hand. Importantly, these investigators delineated abnormalities of sleep architecture, an early indication of the mind and body interactions in this disorder.As time has passed, research has identified significant biologic, psychological, and social abnormalities and effects in FMS. It has taken some time for this jigsaw of observations to form a coherent picture of the nature of FMS. As a consequence, it has also taken a long time to establish effective management strategies for this important clinical and societal problem. Understanding FMS symptomsMany of the initial advances in the understanding of FMS have come from simple clinical observations. For instance, the generalized tenderness in FMS patients, more obvious in some sites than in others, has subsequently been shown to be due to the fundamental biologic process of sensitization as it pertains to the pain system (2,3). The stimulus threshold required to translate an otherwise innocuous sensory input, such as pressure, into pain is significantly lowered in FMS. This ubiquitous neurobiologic process is common to many different parts of the nervous system and translates otherwise subclinical information into perceived sensations, often resulting in unpleasant symptoms. Sensitization is an important function of the pain system after tissue damage, seen both peripherally and centrally, but it is also prominent in pain conditions without obvious tissue damage-induced pain generation, such as FMS. Consideration of this sensitization process in the dorsal horn of the spinal cord can be seen as a useful starting point in the understanding of FMS.Activity within both the unmyelinated C fibers, with related neuropeptide functions including those of substance P, and the faster-transmitting myelinated A-delta fibers is increased in FMS (4,5). These key nociceptor fiber types principally connect to nociceptivespecific projection neurons in the superficial layers of the dorsal horn (Figure 1). A minority of these fiber types also connect to the wide-dynamic range projection neurons, responsive to a broader range of input stimuli and usually more deeply placed in the dorsal horn.Perhaps even more important from the point of view of FMS is the input from the mechanoreceptors, the A-beta fiber system, that predominantly provides sensory proprioceptive information. Although most of this information is rel...

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Treatment of fibromyalgia with antidepressants

Cited by 304 publications

References 47 publications

Maintenance of exercise in women with fibromyalgia

Maintenance of exercise in women with fibromyalgia

A Comparison of Reboxetine and Amitryptilline in the Treatment of Fibromyalgia Syndrome with Co-morbid Depressive Symptoms: An Open-label Preliminary Study

Balanced treatments for fibromyalgia

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