Rheumatology Medical News about fibromyalgia; psychiatric drugs; CNS-linked symptoms

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Fibromyalgia: Psychiatric drugs target CNS-linked symptoms
APCToday, 03/23/09

Stanford SB - Patients with fibromyalgia are a heterogeneous group, yet many describe a common experience: seeing multiple clinicians who seem unable or unwilling to provide a diagnosis or treat their symptoms. Article reports some of the clinical points based on case studies as listed here:

Musculoskeletal pain is not the most problematic symptom for many pts with fibromyalgia
They may suffer from migraine and tension headache, irritable bowel syndrome, mood disorder, and anxiety disorder
Fibromyalgia pts show lower levels of serotonin, norepinephrine, and dopamine metabolites in cerebrospinal fluid
Many pts expect to resume an energetic, pain-free life, which usually is not the case with fibromyalgia
Pregabalin may be a beneficial first choice for pts who report pain and sleep as major issues
Milnacipran’s more selective effect on norepinephrine could be beneficial for pts with excessive fatigue
Other pts may respond better to a more balanced SNRI such as duloxetine, especially those with high levels of anxiety

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