Rheumatology Medical News about Sleeping/Waking brain, Fibromyalgia

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The significance of dysfunctions of the sleeping/waking brain to the pathogenesis and treatment of fibromyalgia syndrome
Rheumatic Disease Clinics of North America, 08/10/09

Moldofsky H et al. – Review summarizes some recent evidence of therapeutic agents that improve sleep physiology, thus facilitating restorative sleep and ameliorating the pain and fatigue symptoms in patients with fibromyalgia syndrome (FMS).

Therapeutic agents that improve sleep physiology and sleep quality should benefit the pain and fatigue of pts who have FMS
Recently approved serotonin–adrenaline reuptake inhibitors for the treatment of FM, duloxetine and milnacipran, are helpful in improving pain symptoms of FM
Duloxetine and milnacipran induce a delay in onset to REM sleep and a reduction of REM sleep
However, unlike SSRI antidepressant drugs that are disruptive to non-REM sleep, duloxetine 80 mg and milnacipran 50 mg twice a day improve sleep continuity and quality
Duloxetine increases in stage 3 SWS and milnacipran facilitates non-REM stage 2 sleep in depressed pts
As yet there are no published sleep physiological studies on either of these two drugs in pts who have FMS
A dopamine agonist, pramipexole, is also reported to improve pain, fatigue, and overall function in a subset of FMS pts

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