Fibromyalgia Flashcards
Fibromyalgia: definition
aka centralized pain disorder
diffuse hyperalgesia and/or allodynia
accompanied by sleep and mood disorders
disturbance in CNS pain processing
Stepwise approach to treatment: initial approach
confirm diagnosis
educate
evaluate and treat comorbidities
Stepwise approach to treatment: first trial
low dose TCA or selected antidepressant/anticonvulsant
Stepwise approach to treatment: not responding to first trial
specialty referral combination of drug therapies PT psych interventions (CBT) multidisciplinary programs
Amitriptyline: class, alternative
TCA
alt: desipramine
Amitriptyline: ADE’s
dry mouth constipation fluid retention weight gain grogginess difficulty concentrating
cardiotoxicity in older pts
Cyclobenzaprine: MOA, ADEs
skeletal muscle relaxant
drowsiness xerostomia altered mental acuity constipation neuromuscular/skeletal weakness blurred vision
Duloxetine:
- MOA
- indication
- ADEs
SNRI
preferred in pts w/ depression
nausea
HA
dry mouth
Milnacipran: MOA, ADEs
SNRI
nausea
HA
constipation
Venlafaxine: MOA, precaution
SNRI
short half life –> withdrawal sx
Gabapentin: class, ADEs
anticonvulsant
dizziness
sedation
lightheadedness
weight gain
Pregabalin: class, ADEs
anticonvulsant
peripheral edema dizziness ataxia xerostomia tremor blurred vision
What medications are NOT considered appropriate treatments for fibromyalgia?
NSAIDs
opioids
6 common medications used in the treatment of fibromyalgia (and their special indications)
amitriptyline
cyclobenzaprine (mild-mod sx, min antidepressant effect)
duloxetine (depression, improve mental fatigue, not general)
milnacipran (sev fatigue and pain)
gabapentin (reduce pain, improve sleep and QOL)
pregabalin (sev sleep disturbance and pain)
