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Treatment for Fibromyalgia: What's New?

In this update article, experts in arthritis present the latest findings on fibromyalgia. Epidemiology and pathophysiology are presented.

Epidemiology includes the characteristics of people affected by fibromyalgia. Pathophysiology is the underlying mechanism (what went wrong). Understanding these two features of any condition helps doctors find the right treatment.

Fibromyalgia or fibromyalgia syndrome (FMS) is a collection of symptoms starting with chronic pain and tender points in many areas of the body. Muscle, joint, or bone pain, and fatigue are present along with a wide range of other symptoms. Women are affected most often, but men can have this problem, too.

A problem with regulating pain in the spinal cord and brain is the most likely cause of FMS. Something triggers the nervous system to register pain sooner and more often than necessary.

This pathophysiologic concept is called neural dysregulation. The person with FMS has increased pain sensitivity. This is referred to as central sensitization and is the focus of new drug treatment. The goal of drug therapy is to down-regulate pain signals.

The FDA has approved the first drug (pregabalin) specifically for FMS management. Other drugs such as anti-depressants and analgesics (pain relievers) are still in use. Many doctors prescribe a combination of drugs. The hope is to decrease pain and fatigue while improving sleep.

Research is focused on finding the right drug in the correct dosage for each affected individual. Higher doses seem to work better but can bring on other unpleasant side effects. Drug therapy should always be part of a total management approach.

Education, exercise, behavioral therapy, and family and social support are important. Many patients are also helped by complementary and alternative medicine (CAM). This includes treatment such as hypnosis, acupuncture, massage, and naturopathic medicine.

References: Philip Mease, MD, and Kristin Seymour. Fibromyalgia Syndrome Update: Emerging Pharmacological Treatments. In The Journal of Musculoskeletal Medicine. October 2007. Vol. 24. No. 10.

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