Drugs of today
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Treating acute and chronic musculoskeletal pain is essential for improving healing of traumatic injuries and surgical procedures, and for improving patient quality of life. Physicians are limited primarily to treating musculoskeletal pain with nonsteroidal antiinflammatory drugs (NSAIDs), cyclooxygenase type 2 (COX-2)-selective NSAIDs such as celecoxib, or narcotics. Patients often treat their pain with over-the-counter NSAIDs. ⋯ Differences in pharmacology between NSAIDs, treatment regimens, experimental models and potential off-target effects also may confuse many of these issues. It is clear, however, that cyclooxygenase activity is involved in the healing of many skeletal tissues, either directly or indirectly through modulation of the inflammatory response. Consequently, pharmacological manipulation of cyclooxygenase using NSAIDs or celecoxib can profoundly affect skeletal health.
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Review
Milnacipran hydrochloride: its efficacy, safety and tolerability profile in fibromyalgia syndrome.
Milnacipran is a serotonin-norepinephrine reuptake inhibitor (SNRI), although its norepinephrine reuptake inhibition predominates. It has been marketed in Europe and Japan as an antidepressant for many years, but only recently has it been investigated as a treatment for fibromyalgia syndrome (FMS). Both open-label and double-blind, placebo-controlled trials have confirmed its efficacy in FMS, not only on the pain component but also on the fluctuating array of other symptoms such as sleep and cognitive disturbances and fatigue The phase III trials have employed comprehensive composite endpoints to more accurately capture the many complex domains of FMS. ⋯ It also demonstrated durability of response for up to 1 year. Its safety and tolerability were typical of its class, and it was generally well tolerated. Further work will be required to establish its place in FMS therapy by comparing it directly with other agents.