1813 01 REUMA3 Editoriale - ME/CFS Australia

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56 P. Sarzi-Puttini et al.rational, genotype-based, pharmacological approach(72). Subjects with the short 5HTTLPR allelein the serotonergic system may be more suitablecandidates for antidepressant treatment (73),whereas subjects with polymorphisms in thedopaminergic system, such as the dopamine D4receptor exon III repeat polymorphism, may becandidates for dopaminergic medications (73).Certainly, further randomized, controlled clinicaltrials that are conducted with subgroups of patientsusing standardized outcome measurements and sufficientlength of follow-up are necessary to observeand document changes in patient symptoms andbehaviors over time.SUMMARYPharmacological treatment has been gradually enriched by a variety of compounds; however, no single drug is capableof fully managing the constellation of fibromyalgia (FM) symptoms. Currently, it is not possible to draw definiteconclusions concerning the best pharmacological approach to managing FM because results of randomized clinical trialspresent methodological limitations and therapeutic programs are too heterogeneous for adequate comparison. However,a variety of pharmacological treatments including antidepressants, nonsteroidal anti-inflammatory drugs(NSAIDS), opioids, sedatives, muscle relaxants and antiepileptics have been used to treat FM with varying results. Inthis review, we will evaluate those pharmacological therapies that have produced the most significant clinical resultsin treating FM patients.The nature of FM suggests that an individualized, multimodal approach that includes both pharmacologic and nonpharmacologictherapies seems to be the most appropriate treatment strategy to date.Key words - Pharmacologic approach, non-pharmacologic approach, opioids, antiepileptics, nonsteroidal anti-inflammatorydrugs.Parole chiave - Terapia farmacologica, terapia non-farmacologica, oppiodi, antiepilettici, anti-infiammatori nonsteroidei.REFERENCES1. Mease P. Fibromyalgia syndrome: review of clinicalpresentation, pathogenesis, outcome measures, andtreatment. J. Rheumatol 2005; 75: 6-21.2. Shmerling RH. A review of fibromyalgia. Am. J ManagCare 2004; 10: 794-800.3. Wolfe F, Smythe HA, Yunus MD. The American Collegeof Rheumatology 1990 Criteria for the Classificationof Fibromyalgia. Report of the Multicenter CriteriaCommittee. Arthritis Rheum 1990; 33: 160-72.4. Sim J, Adams N. Physical and other non-pharmacologicalinterventions for fibromyalgia. Bailliere’s ClinRheumatol 1999; 13: 507-23.5. Offenbaecher M, Stucki G. Physical therapy in the treatmentof fibromyalgia. Scand J Rheumatol 2000; 29:78-85.6. Busch A, Schachter CL, Peloso PM, Bombardier C.Exercise for treating fibromyalgia syndrome. CochraneDatabase Syst Rev 2002 (3): CD003786.7. Keel PJ. Pain management strategies and team approach.Bailliere’s Clin Rheumatol 1999; 13: 493-506.8. Sarzi-Puttini P, Buskila D, Carrabba M, Doria A,Atzeni F. Treatment strategy in fibromyalgia syndrome:where are we now? Semin Arthritis Rheum 2008; 37:353-65.9. Cazzola M, Sarzi-Puttini P, Buskila D, Atzeni F. Pharmacologicaltreatment of fibromyalgia. Reumatismo.2007; 59: 280-91.10. Wolfe F, Zhao S, Lane N. Preference for nonsteroidalantiinflammatory drugs over acetaminophen byrheumatic disease patients: a survey of 1,799 patientswith osteoarthritis, rheumatoid arthritis, and fibromyalgia.Arthritis Rheum. 2000; 43: 378-85.11. Schnitzer TJ. Update on guidelines for the treatment ofchronic musculoskeletal pain. Clin Rheumatol 2006;25 (Suppl 1): S22-9.12. Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F,Branco JC, Buskila D, et al. EULAR. EULAR evidencebasedrecommendations for the management of fibromyalgiasyndrome. Ann Rheum Dis. 2008; 67: 536-41.13. Clauw DJ. Pharmacotherapy for patients with fibromyalgia.J Clin Psychiatry. 2008; 69 Suppl 2: 25-9.14. No authors listed. Now we know: why opioids don’twork against fibromyalgia pain. Recent study revealsreduced opioid receptor availability in the brain; but anew FDA-approved drug brings relief. Health News2008; 14: 3.15. Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E.Opioids for chronic noncancer pain: a meta-analysis ofeffectiveness and side effects. CMAJ 2006; 23, 174:1589-94.16. Biasi G, Manca S, Manganelli S, Marcolongo R. Tramadolin the fibromyalgia syndrome: a controlled clinicaltrial versus placebo. Int J Clin Pharmacol Res 1998;18: 13-9.17. Bennett RM, Kamin M, Karin R, Rosenthal N. Tramadoland acetaminophen combination tablets in the
Fibromyalgia syndrome: the pharmacological treatment options 57treatment of fibromyalgia pain. Am J Med 2003; 114:537-45.18. Bennett RM, Schein J, Kosinski MR, Hewitt DJ, JordanDM, Rosenthal NR: Impact of fibromyalgia pain onhealth-related quality of life before and after treatmentwith tramadol/acetaminophen. Arthritis Rheum 2005;53: 519-27.19. Kress HG. Clinical update on the pharmacology, efficacyand safety of transdermal buprenorphine. Eur JPain. 2008. [Epub ahead of print].20. Harris JD. Management of expected and unexpectedopioid-related side effects. Clin J Pain. 2008; 24: S8-S13.21. Sarzi-Puttini P, Atzeni F, Diana A, Doria A, Furlan RIncreased Neural Sympathetic Activationin FibromyalgiaSyndrome Ann NY Acad Sci 2006; 1069:109-117.22. Gupta A, Silman AJ. Psychological stress and fibromyalgia:a review of the evidence suggesting a neuroendocrinelink. Arthritis Res Ther 2004; 6: 98-106.23. McBeth J, Chiu YH, Silman AJ, Ray D, Morriss R,Dickens C, Gupta A, Macfarlane GJ. Hypothalamic- pituitary-adrenalstress axis function and the relationshipwith chronic widespread pain and its antecedents.Arthritis Res Ther 2005; 7: 992-1000.24. Torta R. Depression as Systemic Disease: the AntidepressantsSpectrum of Action. Psycho-Oncology 2006;15: 3-4.25. Epstein SA, Kay G, Clauw D, Heaton R, Klein D,Krupp L, Kuck J, et al. Psychiatric disorders in patientswith fibromyalgia. A multicenter investigation. Psychosomatics1999; 40: 57-63.26. Henningsen P, Zimmermann T, Sattel H. Medically unexplainedphysical symptoms, anxiety, and depression:a meta-analytic review. Psychosom Med 2003; 65: 528-33.27. Carta MG, Cardia C, Mannu F, Istilla G, Hardoy MC,Anedda C, et al. The high frequency of manic symptomsin fibromyalgia does influence the choice of treatment?Clin Pract Epidem Ment Health 2006; 2: 36.28. Goldenberg DL, Burckhardt C, Crofford L. Managementof fibromyalgia syndrome. JAMA 2004; 292:2388-95.29. Goldenberg D, Mayskiy M, Mossey C, Ruthazer R,Schmid C. A randomized, double-blind crossover trialof fluoxetine and amitriptyline in the treatment of fibromyalgia.Arthritis Rheum 1996; 39: 1852-9.30. Fishbain D. Evidence-based data on pain relief withantidepressants. Ann Med 2000; 32: 305-16.31. Maizels M, McCarberg B. Antidepressants andantiepileptic drugs for chronic non-cancer pain. AmFam Physician 2005; 71: 483-90.32. Arnold LM, Keck PE Jr, Welge JA. Antidepressant treatmentof fibromyalgia: a meta-analysis and review.Psychosomatics 2000; 41: 104-13.33. O’Malley PG, Balden E, Tomkins G, Santoro J,Kroenke K, Jackson JL. Treatment of fibromyalgia withantidepressants: a meta-analysis. J Gen Intern Med2000; 15: 659-66.34. Wolfe F, Cathey MA, Hawley DJ. A double-blindplacebo controlled trial of fluoxetine in fibromyalgia.Scand J Rheumatol 1994; 23: 255-9.35. Norregaard J, Volkmann H, Danneskiold-Samsoe B. Arandomized controlled trial of citalopram in the treatmentof fibromyalgia. Pain 1995; 61: 445-9.36. Anderberg UM, Marteinsdottir I, von Knorring L.Citalopram in patients with fibromyalgia: a randomized,double-blind, placebo-controlled study. Eur J Pain2000; 4: 27-35.37. Arnold LM, Hess EV, Hudson JI, Welge JA, Berno SE,Keck PE Jr. A randomized, placebo-controlled, doubleblind,flexible-dose study of fluoxetine in the treatmentof women with fibromyalgia. Am J Med 2002; 112:191-7.38. Torta R, Lacerenza M. Depressione e Dolore, Utet, Milano2002; 199.39. Torta R, Berra C. La terapia neuropsicofarmacologicanel dolore. In: Torta R., Mussa A: PsicOncologia. Il modellobiopsicosociale. Centro Scientifico Editore, Torino,2007.40. Arnold LM, Hess EV, Hudson JI, Welge JA, Berno SE,Keck PE Jr. A randomized, placebo-controlled, doubleblind,flexible-dose study of fluoxetine in the treatmentof women with fibromyalgia. Am J Med 2002; 112:191-7.41. Perrot S, Maheu E, Javier RM, Eschalier A, CoutauxA, LeBars M, et al. Guidelines for the use of antidepressantsin painful rheumatic conditions. Eur J Pain.2006; 10: 185-92.42. Sindrup SH, Otto M, Finnerup NB, Jensen TS. Antidepressantsin the treatment of neuropathic pain. BasicClin Pharmacol Toxicol 2005; 96: 399-409.43. Arnold LM, Lu Y, Crofford LJ, Wohlreich M, DetkeMJ, Iyengar S, Goldstein DJ. A double-blind, multicentertrial comparing duloxetine with placebo in thetreatment of fibromyalgia patients with or without majordepressive disorder. Arthritis Rheum 2004; 50:2974-84.44. Russell IJ, Mease PJ, Smith TR, Kajdasz DK, WohlreichMM, Detke MJ, et al Efficacy and safety of duloxetinefor treatment of fibromyalgia in patients with orwithout major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled,fixed-dose trial. Pain 2008; 136: 432-44.45. Vitton O, Gendreau M, Gendreau J, Kranzler J, Rao SG.A double-blind placebo-controlled trial of milnacipranin the treatment of fibromyalgia. Hum PsychopharmacolClin Exp 2004; 19: 27-35.46. 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