Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Leventhal, L. J.    Related Articles in PubMed    PubMed Citation    PubMed

UPDATE

Management of Fibromyalgia

Lawrence J. Leventhal, MD

7 December 1999 | Volume 131 Issue 11 | Pages 850-858

Despite extensive clinical study, there is no distinct consensus on the optimal management of fibromyalgia. The cause of fibromyalgia has not been clearly defined, but several mechanisms may be involved. Abnormalities in sleep patterns, muscle structure, and cerebral blood flow have been associated with the syndrome, but it is unclear whether a causal relation exists between these abnormalities and fibromyalgia. Recent evidence suggests that alterations in the metabolism and function of the neurotransmitters serotonin, norepinephrine, and substance P may contribute to the development of fibromyalgia. No pharmacologic agents are indicated specifically for the treatment of fibromyalgia in the United States, and most pharmacologic therapies show only limited success, although drugs that affect serotonin or norepinephrine at the receptor site (such as antidepressants or tramadol) seem to generate the most consistent results. Tricyclic antidepressants may diminish the sleep disturbance and pain caused by fibromyalgia, whereas selective serotonin reuptake inhibitors may be more useful for sleep and coexistent depression only. Among the commonly used analgesics, preliminary data suggest that tramadol may be useful for treatment of fibromyalgia pain and that trigger-point injections may be helpful. Controlled trials of anti-inflammatory agents have demonstrated little usefulness of these drugs, and oral opioids have not been studied for this condition. Miscellaneous agents, such as growth hormone, tropisetron or ondansetron, 5-hydroxytryptophan, -hydroxybutyrate, and S-adenosyl- L-methionine, have also shown promising preliminary results, but their clinical roles remain to be defined. Nonpharmacologic interventions (such as exercise, biofeedback, and electroacupuncture) have likewise shown some success. Therefore, a multidisciplinary approach that includes both pharmacologic and nonpharmacologic strategies is recommended.

Author and Article Information

From Graduate Hospital, Philadelphia, Pennsylvania.

Grant Support: In part by an unrestricted educational grant from Ortho-McNeil Pharmaceutical.

Requests for Reprints: Lawrence Leventhal, MD, Graduate Hospital, Pepper Pavilion, Suite 801, 1800 Lombard Street, Philadelphia, PA 19146-1497.

Related articles in Annals:

Letters
Management of Fibromyalgia
Frederick Wolfe

Annals 2000 132: 1004. [Full Text]  

Letters
Management of Fibromyalgia
Arthur Huppert

Annals 2000 132: 1004. [Full Text]  

Letters
Management of Fibromyalgia
Norman Muilenburg

Annals 2000 132: 1004-1005. [Full Text]  

Letters
Management of Fibromyalgia
Hideto Akama

Annals 2000 132: 1005. [Full Text]  

Letters
Management of Fibromyalgia
Lawrence J. Cohn

Annals 2000 132: 1005. [Full Text]  

Letters
Management of Fibromyalgia
Lawrence J. Leventhal

Annals 2000 132: 1005. [Full Text]  

This article has been cited by other articles:

				L. Brosseau, G. A Wells, P. Tugwell, M. Egan, K. G Wilson, C.-J. Dubouloz, L. Casimiro, V. A Robinson, J. McGowan, A. Busch, et al. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Aerobic Fitness Exercises in the Management of Fibromyalgia: Part 1 Physical Therapy, July 1, 2008; 88(7): 857 - 871. [Abstract] [Full Text] [PDF]

				A. S. Russell and S. L. Aaron Opioids and chronic pain Can. Med. Assoc. J., October 28, 2003; 169(9): 902 - 904. [Full Text]

				C. L Schachter, A. J Busch, P. M Peloso, and M S. Sheppard Effects of Short Versus Long Bouts of Aerobic Exercise in Sedentary Women With Fibromyalgia: A Randomized Controlled Trial Physical Therapy, April 1, 2003; 83(4): 340 - 358. [Abstract] [Full Text] [PDF]

				A. C. Steere A 58-Year-Old Man With a Diagnosis of Chronic Lyme Disease JAMA, August 28, 2002; 288(8): 1002 - 1010. [Full Text] [PDF]

				F. Wolfe Management of Fibromyalgia Ann Intern Med, June 20, 2000; 132(12): 1004 - 1004. [Full Text] [PDF]

				H. Akama Management of Fibromyalgia Ann Intern Med, June 20, 2000; 132(12): 1005 - 1005. [Full Text] [PDF]

				A. Huppert Management of Fibromyalgia Ann Intern Med, June 20, 2000; 132(12): 1004 - 1004. [Full Text] [PDF]

				N. Muilenburg Management of Fibromyalgia Ann Intern Med, June 20, 2000; 132(12): 1004 - 1005. [Full Text] [PDF]

				L. J. Cohn Management of Fibromyalgia Ann Intern Med, June 20, 2000; 132(12): 1005 - 1005. [Full Text] [PDF]