The target continues to be central neurotransmission when it comes to improving the pain of fibromyalgia. This is of course based on the working hypothesis that the perception of pain is altered in those suffering from fibromyalgia.
By now, many are familiar with Lyrica, particularly with the television commercials featuring that drug. And it has been helpful in fibromyalgia. Lyrica lowers the level of pain in many who take it, as it decreases the expression of those biochemicals which transmit the message of pain to our brains, including glutamate and substance P. The clinical study results were so impressive that last year the United States Food and Drug Administration (FDA) approved Lyrica for the treatment fibromyalgia. No other drug thus far has achieved such a designation. It is no cure, but for many patients it has truly changed their lives.
But not all patients have had significant results with Lyrica, and so research continues.
Cymbalta is a serotonin-norepinephrine reuptake inhibitor which is currently FDA approved for the treatment of diabetic neuropathy, depression, and generalized anxiety disorder. But the makers of Cymbalta did last year ask the FDA for approval for the treatment of fibromyalgia. Interestingly, patients who took part in the Cymbalta studies and who had major depression were allowed to continue in the studies. The statisticians were able to show that Cymbalta's pain-improving power is related to its effect on pain signal transmission, and not due to its ability to alleviate depression.
When I was in Okinawa, Japan recently, I gave a lecture on fibromyalgia. At that time, I briefly discussed a drug being studied for the treatment of fibromyalgia which was available in Japan, but not the United States. That drug is Milnacipran.
Milnacipran is, like Cymbalta, a norepinephrine-serotonin reuptake inhibitor. Three studies presented at the recent American College of Rheumatology (ACR) annual scientific meeting this past November show that Milnacipran appears to be safe and effective in the treatment of fibromyalgia.
Fibromyalgia patients reported that Milnacipran not only improved pain, but also allowed for improvement in physical functioning. Improvements were noted to last at least six months. And the side effects were fairly minor: headache and nausea were the most common side effects. Relatively rarely did patients report palpitations, elevated blood pressure, sweating, constipation and dizziness.
Studies on what causes fibromyalgia, of course, are ongoing. At the ACR meeting in Boston a couple of months back, the focus of many of the studies involved exploring what is wrong with how the brain processes pain in fibromyalgia. The treatments in turn are focusing on modifying how the brain processes pain signals.
Hopefully, all this translates into quality treatment options for the many who suffer from the chronic pain of fibromyalgia. The studies show things are definitely looking up.
Published On: January 28, 2008