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FMS Treatment - continuation
Pharmacotherapy

PAINKILLERS

Pain is the major symptom of fibromyalgia. However, one has to underline that commonly used painkillers and NSAIDs (non-steroid anti-inflammatory drugs) hardly ease the FMS pain or do not give any relief at all. This is one of the elements of differentiating diagnosis and it has also to be taken into consideration when it comes to therapy.

Tramadol (brand name Ultram) is a narcotic-like painkiller. Despite of pain relieving effect tramadol also shows an inhibiting effect of the reuptake of serotonin and norepinephrine and because of this it may reduce FMS symptoms. However, it has number of possible adverse effects and may be habit-forming, even at regular doses.

ANTIDEPRESSANTS

Because many FMS patients show serotonin deficiency, pharmaceuticals that increase serotonin level in CNS have been tried. Selective serotonin re-uptake inhibitors (SSRI) have been tried initially. SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by inhibiting its reuptake into the presynaptic cell, increasing the level of serotonin in the synaptic cleft available to bind to the postsynaptic receptor. However, their effect on reduction of FMS symptoms was pretty limited

More recently promising effect has shown venlafaxine (brand name: Effexor). It is an antidepressant of the serotonin-norepinephrine reuptake inhibitor (SNRI) class. This means it increases the concentrations of the neurotransmitters serotonin and norepinephrine in the body and the brain. It is licensed for the treatment of major depressive disorder (MDD), generalised anxiety disorder (GAD), panic disorder and social phobia.

ANTIEPILEPTIC

This group of pharmaceuticals has been also used the treatment of neuropathic pain. There were some attempts with carbamazepine (Tegretol) and oxcarbazepine (Trileptal). However, these drugs show limited impact on FMS and relatively high number of adverse effects.

Much more promising is pregabalin (brand name Lyrica), which shows anticonvulsive, anxiolytic and analgesic effects. It is successfully used for the treatment of neuropathic pain in diabetic patients. Pregabalin gives also improvement in some FMS patients. It also improves sleep quality and the quality of live in neuropathic pain patients, and it is generally well tolerated.

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