[CO-CURE] RES: Therapy Insight: fibromyalgia-a different type of pain ne...

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In a message dated 8/26/2006 10:24:41 PM Eastern Daylight Time,

bernicemelsky@... writes:

Therapy Insight: fibromyalgia-a different type of pain needing a different

type of treatment.

Nature Clinical Practice. Rheumatology. 2006 Jul;2(7):364-372.

Dadabhoy D, Clauw DJ.

D Dadabhoy is a Clinical Lecturer in Rheumatology at the University of

Michigan, MI, USA, where DJ Clauw is a Professor of Medicine, the Director

of the Chronic Pain and Fatigue Research Center and the Center for the

Advancement of Clinical Research, and the Assistant Dean for Clinical and

Translational Research.

PMID: 16932722

In the past decade, we have made tremendous progress in our understanding

of fibromyalgia, which is now recognized as one of many 'central' pain

syndromes that are common in the general population. Specific genes that

might confer an increased risk of developing fibromyalgia syndrome are

beginning to be identified and the environment (in this case exposure to

stressors) might also have a significant effect on triggering the

expression of symptoms.

After developing the syndrome, the hallmark aberration noted in individuals

with fibromyalgia is augmented central pain processing. Insights from

research suggest that fibromyalgia and related syndromes require a

multimodal management program that is different from the standard used to

treat peripheral pain (i.e. acute or inflammatory pain). Instead of the

nonsteroidal anti-inflammatory drugs and opioids commonly used in the

treatment of peripheral pain, the recommended drugs for central pain

conditions are neuroactive compounds that downregulate sensory processing.

The most efficacious compounds that are currently available include the

tricyclic drugs and mixed reuptake inhibitors that simultaneously increase

serotonin and norepinephrine concentrations in the central nervous system.

Other compounds that increase levels of single monoamines (serotonin,

norepinephrine or dopamine), and anticonvulsants also show efficacy in this

condition.

In addition to these pharmacologic therapies, which are useful in improving

symptoms, nonpharmacologic therapies such as exercise and cognitive

behavioral therapy are useful treatments for restoring function to an

individual with fibromyalgia.

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mjh

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