Human psychopharmacology
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Human psychopharmacology · Jun 2009
Multicenter StudyFunctional magnetic resonance imagery (fMRI) in fibromyalgia and the response to milnacipran.
Functional imaging has been used to study response to pain in fibromyalgia patients. Functional magnetic resonance imagery (fMRI) which tracks local changes in blood flow has a higher spatial and temporal resolution than other techniques such as positron emission tomography (PET) or single-photon emission tomography (SPECT). fMRI studies in fibromyalgia patients suggest that similar levels of subjective pain result in similar central nervous system (CNS) activation in both fibromyalgia patients and controls. ⋯ The hypothesis that increased sensitivity to pain is due to decreased activity of the descending inhibitory pathways is supported by results with milnacipran. Fibromyalgia patients treated with the serotonin and noradrenaline reuptake inhibitor, milnacipran, exhibited a reduction in pain sensitivity and a parallel increase in activity in brain regions implicated in the descending pain inhibitory pathways compared to placebo-treated patients.
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Human psychopharmacology · Jun 2009
ReviewFibromyalgia: a complex syndrome requiring a multidisciplinary approach.
Fibromyalgia is a pain syndrome which is not due to tissue damage or inflammation and is thus fundamentally different from rheumatic disorders and many other pain conditions. In addition to widespread pain it is associated with a range of other symptoms such as sleep disturbance, fatigue, cognitive disturbance, stiffness and depressive symptoms. ⋯ In particular, serotonin noradrenaline reuptake inhibitors (SNRI) such as duloxetine and milnacipran and alpha2-delta receptor ligands such as pregabalin have been shown, in a variety of placebo-controlled studies, to bring significant relief from pain and other symptoms. The complex symptomatology of fibromyalgia will, however, continue to require a multidisciplinary approach including education and exercise in addition to drug therapy to achieve the most efficient management of fibromyalgia.
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Fibromyalgia is usually treated by rheumatologists but since co-morbid depression and anxiety are frequent, psychiatrists are likely to be confronted with patients suffering from the syndrome. The symptoms associated with fibromyalgia vary from patient to patient but there is one common symptom-they ache all over. In addition to pain, patients report headaches, poor sleep, fatigue, depressed mood and irregular bowel habits, which are also all symptoms of depression. ⋯ Treatment of fibromyalgia requires a comprehensive approach involving education, aerobic exercise and cognitive behavioural therapy in addition to pharmacotherapy. The most effective drugs available for the treatment for fibromyalgia, the serotonin noradrenaline reuptake inhibitors, milnacipran and duloxetine and the anti-epileptic, pregabalin, are well known to psychiatrists. Thus the psychiatrist is well placed to initiate treatment in these patients.