Chronic Fatigue/Fibromyalgia Compounding

Fibromyalgia

Pharmacotherapy for fibromyalgia has become more prevalent in clinical practice as our understanding of the cellular, molecular and pathophysiologic mechanisms contributing to widespread musculoskeletal and neuropathic pain has evolved. Thus, several pain pathways including high-voltage activated Ca2+ channels and the Kv1 family of K+ ion channels appear related to the efficacy of pregabalin and amitriptyline, respectively. Serotonin and norepinephrine reuptake inhibitors – including mirtazapine, duloxetine and milnacipran – appear to be more efficacious in FMS than selective serotonin reuptake inhibitors.

Clin Exp Rheumatol. 2009 Sep-Oct;27(5 Suppl 56):S86-91.
Focus on pain mechanisms and pharmacotherapy in the treatment of fibromyalgia syndrome.
Malemud CJ.
Division of Rheumatic Diseases, Case Western Reserve University School of Medicine.
Click here to access the PubMed abstract of this article.

Low-dose naltrexone reduced the fibromyalgia symptoms in the entire cohort participating in the below study. In addition, side effects (including insomnia and vivid dreams) were rare, and described as minor and transient. Study writer conclude that LDN “may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia.

Pain Med. 2009 May-Jun;10(4):663-72. Epub 2009 Apr 22.
Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study.
Younger J, Mackey S.
Click here to access the PubMed abstract of this article.

Dr. Ian Carroll, MD, MS, and Dr. Jarred Younger, PhD, of the Stanford Systems Neuroscience and Pain Lab are conducting a clinical trial to investigate the use of T3 and Low Dose Naltrexone (LDN) for the treatment of fibromyalgia. Hypothyroid patients who have been treated with T3 have experienced some improvement in symptoms of fibromyalgia.

http://snapl.stanford.edu/t3/
Accessed January 2012

LDN reduced fibromyalgia symptoms in ten women meeting criteria for fibromyalgia, with a greater than 30% reduction of symptoms over placebo. In addition, laboratory visits showed that mechanical and heat pain thresholds were improved by the drug while side effects were rare, and described as minor and transient.

Pain Med. 2009 May-Jun;10(4):663-72. Epub 2009 Apr 22.
Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study.
Younger J, Mackey S.
Click here to access the PubMed abstract of this article.

Considering the refractory nature of fibromyalgia to conventional pain treatments, the IV ketamine test might enhance patient care by saving time and reducing unnecessary treatment trials.

J Pain. 2006 Jun;7(6):391-8.
The intravenous ketamine test predicts subsequent response to an oral dextromethorphan treatment regimen in fibromyalgia patients.
Cohen SP, Verdolin MH, Chang AS, Kurihara C, Morlando BJ, Mao J.
Click here to access the PubMed abstract of this article.

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