Chronic Fatigue/Fibromyalgia


Fibromyalgia

Pharmacotherapy for fibromyalgia has become more prevalent in clinical practice as our understanding of the cellular, molecular and pathophysiologic mechanisms contributing to widespread musculoskeletal and neuropathic pain has evolved. Thus, several pain pathways including high-voltage activated Ca2+ channels and the Kv1 family of K+ ion channels appear related to the efficacy of pregabalin and amitriptyline, respectively. Serotonin and norepinephrine reuptake inhibitors - including mirtazapine, duloxetine and milnacipran - appear to be more efficacious in FMS than selective serotonin reuptake inhibitors.

Clin Exp Rheumatol. 2009 Sep-Oct;27(5 Suppl 56):S86-91.
Focus on pain mechanisms and pharmacotherapy in the treatment of fibromyalgia syndrome.
Click here to access the PubMed abstract of this article.


Fibromyalgia Pain Reduced by Low-Dose Naltrexone

Low-dose naltrexone (LDN) has been found to be an effective, highly tolerable, and inexpensive treatment to reduce daily pain in patients with fibromyalgia, according to the results of a placebo-controlled, double-blind trial, reported at the American Academy of Pain Medicine’s 28th Annual Meeting in February, 2012. At the end of the trial, patients reported a 43% reduction in pain during the LDN treatment when compared to the placebo treatment. This study was a follow-up to a preliminary pilot study, see below.

Pain Med. 2012;13(2):Abstract 251.
Low-Dose Naltrexone Reduces the Symptoms of Fibromyalgia: A Double-Blind and Placebo-Controlled Crossover Study
Click here to access the PubMed abstract of this article.


LDN can be beneficial in pain management for patients with fibromyalgia, with minimal side effects and a high degree of tolerance. Further study is warranted.

Pain Med. 2009 May-Jun;10(4):663-72. Epub 2009 Apr 22.
Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study.
Click here to access the PubMed abstract of this article.


LDN reduced fibromyalgia symptoms in ten women meeting criteria for fibromyalgia, with a greater than 30% reduction of symptoms over placebo. In addition, laboratory visits showed that mechanical and heat pain thresholds were improved by the drug while side effects were rare, and described as minor and transient.

Pain Med. 2009 May-Jun;10(4):663-72. Epub 2009 Apr 22.
Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study.
Click here to access the PubMed abstract of this article.



Considering the refractory nature of fibromyalgia to conventional pain treatments, the IV ketamine test might enhance patient care by saving time and reducing unnecessary treatment trials.

J Pain. 2006 Jun;7(6):391-8.
The intravenous ketamine test predicts subsequent response to an oral dextromethorphan treatment regimen in fibromyalgia patients.
Click here to access the PubMed abstract of this article.