Fibromyalgia (FM) is a condition characterized by stiffness, non-restorative sleep, chronic fatigue, and widespread musculoskeletal pain. The pain is persistent when the tender points are palpated, but unlike myofascial pain, the patients do not complain about burning pain localized in specific sites (LeBlond, Brown, & DeGowin, 2009). FM is diagnosed by palpating 18 standardized tender points, which are bilaterally distributed on the anterior and posterior sides, and the diagnosis is concluded if the patient experiences pain in at least 11 points (Arcangelo & Peterson, 2013). Although the exact cause of FM is unknown, many healthcare providers and researchers consider it a psychosomatic disorder (Arcangelo & Peterson, 2013) while others believe it is a central nervous system disorder that is caused by neurological abnormalities found only in FM patients (Ngian, Guymer, & Littlejohn, 2011).
There is no standard approach to drug therapy in FM cases, but the goal is to alleviate symptoms and control the disorder. Because the disorder is chronic, it is important to monitor dosage to prevent long-term adverse events. Tricyclic antidepressants (TCAs) are effective for improving sleep patterns, and they can be used up to one year without experiencing adverse effects, so they are used in the first line of therapy (Arcangelo & Peterson, 2013). The second line of therapy can taper the dosage of TCAs and introduce selective serotonin reuptake inhibitors or nonsteroidal anti-inflammatory drugs. If both lines are ineffective, narcotic analgesics, such as oxycodone or codeine, can be introduced. However, those drugs should never be administered to patients with potential substance addiction issues or used as a long-term strategy because of associated adverse events (Ngian et al., 2011).
Gender plays an important role in FM because the disorder primarily affects women (LeBlond et al., 2009). According to Yunus, 90 percent of FM patients are women, and they often have more tender points than men, even though the pain severity and other functions are not significantly different (as cited in Arcangelo & Peterson, 2013). In planning pharmacotherapy for women, it is important to consider that amitriptyline and cyclobenzaprine are teratogenic category D TCAs and should be avoided in women who are of childbearing age, pregnant, or breastfeeding (Arcangelo & Peterson, 2013).
References
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin's diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.
Ngian, G. S., Guymer, E. K., & Littlejohn, G. O. (2011). The use of opioids in fibromyalgia. International Journal of Rheumatic Diseases, 14(1), 6-11.
