Prescrire Int. 2009 Aug;18(102):169-73.Compound (MeSH Keyword), Substance
(MeSH Keyword), LinkOut
[No authors listed]
(1) Fibromyalgia is characterised by a range of symptoms that include muscle
pain, fatigue and sleep disorders. Anxiety and depression are often also
present. The cause is unknown. More women than men are affected; (2) The
following review focuses on differential diagnoses and available treatments
for fibromyalgia, based on a review of the literature using the standard
Prescrire methodology; (3) Fibromyalgia is mainly diagnosed by excluding
other possibilities. The principal differential diagnoses are rheumatic
involvement of the spine, systemic inflammatory disorders, and
hypothyroidism. Unlike these other conditions, fibromyalgia is not
associated with radiological or laboratory abnormalities; (4) Paracetamol
has not been compared with other treatments in fibromyalgia. Nonsteroidal
antiinflammatory drugs have no specific effect; (5) The only two trials
assessing tramadol showed little effect; in one study the average pain score
was 53 mm in the tramadol group versus 65 mm in the placebo group, on a
scale ranging from 0 to 100 mm. The adverse effects of tramadol are those of
opiates in general, mainly nausea and dependence. Tramadol interacts with
numerous other drugs; (6) The efficacy of tricyclic antidepressants is also
difficult to quantify. Their limited superiority over placebo lasts no more
than a few months. The efficacy of selective serotonin reuptake inhibitor
antidepressants (fluoxetine, paroxetine and citalopram), serotonin and
nonadrenaline reuptake inhibitors (duloxetine and milnacipran) is even less
well established. Duloxetine has been tested in four placebo-controlled
trials with unconvincing results; (7) Pregabalin and gabapentin, two
antiepileptic drugs, appear to be more effective than placebo but have only
been tested in short-term trials. In one trial 44% of patients in the
pregabalin group said they felt better after 13 weeks versus 35% of patients
in the placebo group. However, adverse effects are frequent and sometimes
troublesome (drowsiness, dizziness, nausea, weight gain). In clinical
trials, 19% to 33% of patients stopped treatment due to adverse effects
after 13 weeks, depending on the dose of pregabalin; (8) Assessments of
non-drug treatments in this setting are generally mediocre. The
best-assessed alternative therapies (acupuncture and physical exercise) only
have a limited effect; (9) In practice, when a patient presents with
symptoms compatible with fibromyalgia, the first step is to rule out a
treatable condition. Quality of life may be improved by first acknowledging
that the pain is real, and possibly by providing psychological, medical,
social and occupational support. The limited efficacy of available drugs,
and their potential adverse effects, should be discussed with the patient.
PMID: 19746561 [PubMed - indexed for MEDLINE]
