fibromyalgia Flashcards
characteristics of fibromyalgia?
Pain is distinctly different from nociceptive pain
Disengaged from noxious stimuli or healing
Widespread musculoskeletal pain with no cause identified
pathophys of fibromyalgia
Central Sensitization or Centralized Pain:
- Characterized by disturbance in CNS pain processing
- Responsive to neuroactive compounds altering levels of neurotransmitters involved in pain transmission
Non-pharmacological treatments
Patient education Graded exercise CBT (OT or Psych) CAM CNS neurostimulatory therapies
Pharmacotherapy for FM
Amitriptyline Cyclobenzaprine Duloxetine (Cymbalta) Milnacipran (Savella) Gabapentin Pregabalin (Lyrica)
minority of patients experienced substantial improvement
Moderate degrees of benefit were seen in pain and sleep
MOA for TCA’s (amitriptyline and desipramine)?
TCA-blockade of NET and SERT channels
initial dose 10mg QHS, usual final 25-50mg
ADE’s for TCA’s (amitriptyline and desipramine)?
dry mouth, constipation, fluid retention, weight gain, grogginess, difficulty concentrating are common
side effects and possible cardiotoxicity limit use in older patients
MOA for cyclobenzaprine?
Centrally acting skeletal muscle relaxant pharmacologically related to TCAs
indications for cyclobenzaprine?
Mild to moderate symptoms
Minimal antidepressant effect
ADE’s for cyclobenzaprine?
Drowsiness, xerostomia, change in mental acuity, constipation, neuromuscular and skeletal weakness, blurred vision
MOA for Duloxetine and Milnacipran
SNRI
Uses for duloxetine
May be preferred in patients with depression requiring therapy
Take in AM with breakfast
Initial dose 20-30mg/day to final of 60mg/day
Mental fatigue improved, but general fatigue did not
ADE’s for duloxetine
nausea, headache, and dry mouth
usually occurred within the first three months of therapy
