Fibromyalgia is a chronic pain syndrome that is very difficult to treat. This condition is characterized by diffuse pain lasting more than 3 months in various parts of the body and the presence of pain in 11 of 18 painful points.
In addition, with fibromyalgia there is stiffness, increased fatigue, sleep that does not bring a sense of relaxation, depression, anxiety and cognitive impairment. Fibromyalgia is more common in women.
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Currently, medication methods, physiotherapy exercises, physiotherapy, autogenous therapy and other treatment methods are used to treat fibromyalgia. Over the past 10 years, some success has been achieved in the treatment of fibromyalgia: it is possible to achieve the relief of some symptoms and functional disorders, to improve the quality of life of patients.
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Pregabalin was approved for the treatment of neuropathic pain as an additional treatment for partial seizures in adults, generalized anxiety disorder and was the first drug approved by the FDA for the treatment of fibromyalgia.
The second group of drugs after TCA, which are often used in studies of fibromyalgia, is muscle relaxants, in particular cyclobenzaprine. A meta-analysis of the results of studies on the use of cyclobenzaprine for the relief of pain in fibromyalgia showed that the drug has an effect similar to amitriptyline. Even such low doses, as 1-4 mg at night, showed analgesic activity in fibromyalgia.
Tramadol is a central-action analgesic that binds to β-opioid receptors and inhibits the reuptake of norepinephrine and serotonin. The combination of acetaminophen with tramadol in a ratio of 8: 1 showed the synergism of both drugs in preclinical pain models. During a 13-week multicenter RCT, tramadol / paracetamol in doses of 37.5 mg / 325 mg relieved pain in fibromyalgia more effectively than placebo.
The effectiveness of benzodiazepines in the treatment of fibromyalgia is not fully understood. Many studies have produced conflicting results. For example, benzodiazepines, including alprazolam (0.5-3.0 mg at bedtime), did not show an advantage over placebo for the treatment of pain with fibromyalgia, but clonazepam effectively stopped the pain of the temporomandibular joint, which is often observed with fibromyalgia.
The systemic use of lidocaine was also used to treat patients with fibromyalgia: single and course infusions of lidocaine at doses of 5-7 mg / kg led to a fairly noticeable reduction in pain in patients with fibromyalgia . In a recent RCT involving patients with fibromyalgia, 50 mg of lidocaine was injected into a sore spot in the area of the trapezius muscle. As a result, not only a local decrease in pain at the injection site was noted, but also a general analgesic effect.