Fibromyalgia: do I tackle you with pharmacological treatments?

Abstract. Pharmacological approaches are frequently proposed in fibromyalgia, based on different rationale. Some treatments are proposed to alleviate symptoms, mainly pain, fatigue, and sleep disorder. Other treatments are proposed according to pathophysiological mechanisms, especially central sensi...

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Main Author: Serge Perrot
Format: Article
Language:English
Published: Wolters Kluwer 2025-02-01
Series:PAIN Reports
Online Access:http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001222
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author Serge Perrot
author_facet Serge Perrot
author_sort Serge Perrot
collection DOAJ
description Abstract. Pharmacological approaches are frequently proposed in fibromyalgia, based on different rationale. Some treatments are proposed to alleviate symptoms, mainly pain, fatigue, and sleep disorder. Other treatments are proposed according to pathophysiological mechanisms, especially central sensitization and abnormal pain modulation. Globally, pharmacological approaches are weakly effective but market authorization differs between Europe and United States. Food and Drug Administration–approved medications for fibromyalgia treatment include serotonin and noradrenaline reuptake inhibitors, such as duloxetine, and pregabalin (an anticonvulsant), which target neurotransmitter modulation and central sensitization. Effect of analgesics, especially tramadol, on pain is weak, mainly on short term. Low-dose naltrexone and ketamine are gaining attention due their action on neuroinflammation and depression modulation, but treatment protocols have not been validated. Moreover, some treatments should be avoided due to the high risk of abuse and severe side effects, especially opioids, steroids, and hormonal replacement.
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spelling doaj-art-c963422f238b46bf897ec2c2c7a6acc82025-01-24T09:20:44ZengWolters KluwerPAIN Reports2471-25312025-02-01101e122210.1097/PR9.0000000000001222PR90000000000001222Fibromyalgia: do I tackle you with pharmacological treatments?Serge Perrot0Pain Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, INSERM U987, Paris, FranceAbstract. Pharmacological approaches are frequently proposed in fibromyalgia, based on different rationale. Some treatments are proposed to alleviate symptoms, mainly pain, fatigue, and sleep disorder. Other treatments are proposed according to pathophysiological mechanisms, especially central sensitization and abnormal pain modulation. Globally, pharmacological approaches are weakly effective but market authorization differs between Europe and United States. Food and Drug Administration–approved medications for fibromyalgia treatment include serotonin and noradrenaline reuptake inhibitors, such as duloxetine, and pregabalin (an anticonvulsant), which target neurotransmitter modulation and central sensitization. Effect of analgesics, especially tramadol, on pain is weak, mainly on short term. Low-dose naltrexone and ketamine are gaining attention due their action on neuroinflammation and depression modulation, but treatment protocols have not been validated. Moreover, some treatments should be avoided due to the high risk of abuse and severe side effects, especially opioids, steroids, and hormonal replacement.http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001222
spellingShingle Serge Perrot
Fibromyalgia: do I tackle you with pharmacological treatments?
PAIN Reports
title Fibromyalgia: do I tackle you with pharmacological treatments?
title_full Fibromyalgia: do I tackle you with pharmacological treatments?
title_fullStr Fibromyalgia: do I tackle you with pharmacological treatments?
title_full_unstemmed Fibromyalgia: do I tackle you with pharmacological treatments?
title_short Fibromyalgia: do I tackle you with pharmacological treatments?
title_sort fibromyalgia do i tackle you with pharmacological treatments
url http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001222
work_keys_str_mv AT sergeperrot fibromyalgiadoitackleyouwithpharmacologicaltreatments