Fibromyalgia Research Looks at Milnacipran and Cymbalta

Dr. Mark Borigini Health Guide
  • The sessions on fibromyalgia were rather popular at last week's American College of Rheumatology (ACR) Annual Scientific Meeting in San Francisco. One session I attended began at 8:00 one morning; by 8:10, the rather generous tray of croissants had been reduced to two, and one of those was missing ¼ of its original self, most likely the victim of one of our more calorie-conscious ACR members.


    While there were certainly no breakthroughs, there were a number of studies presented regarding treatments which have been discussed in these virtual pages in the past, and which confirm their usefulness in the treatment of fibromyalgia.

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    Milnacipran continues to look good. This is the dual reuptake inhibitor of norepinephrine (NE) and serotonin (5-HT), with preference for NE reuptake inhibition.


    Two studies were discussed which demonstrated pain improvement in fibromyalgia over a 15 week period. Another study found improvements in fibromyalgia symptoms are sustained for one year with milnacipran treatment: Study subjects showed improvements of up to 47% in 24-hour pain recall scores, and up to 47% improvement in weekly pain recall scores. Those treated with milnacipran also showed improvements in stiffness, tiredness, and depressed mood. The most commonly reported side effect was nausea (in about 18% of the study subjects taking milnacipran).


    The effect milnacipran has on fatigue was examined in another study, as it is known that up to 90% of fibromyalgia patients suffer from fatigue which can last many years, and which can be profoundly disabling. And it was shown that milnacipran has beneficial effects as soon as one week of treatment; these were sustained for the duration of the 15 week study. Fatigue improved to a greater extent in pain responders compared to all placebo-treated patients-including pain responders and non-responders.


    As many readers know, many medications used to treat fibromyalgia can cause weight gain. Researchers presented results last week of the analysis of two large studies involving milnacipran treatment of fibromyalgia patients: Interestingly, it was found that fibromyalgia patients treated with milnacipran tended to LOSE weight compared to patients on placebo. Now, that was refreshing and welcome news.


    Another piece of croissant anyone?

    Speaking of NE reuptake inhibitors, a new one was introduced at the meeting: It is called esreboxetine, and it is described as a highly selective NE reuptake inhibitor.


    The results from a very preliminary study show it may be effective in relieving the pain and fatigue fibromyalgia patients experience. In fact, 43% of patients stated their condition was much improved as a result of taking esreboxetine, compared to just 23% of patients treated with placebo. The most common side effects were constipation, insomnia, dry mouth, headache and nausea.


    We will all have to watch for further information on this new drug.

    A study looking at the impact of Cymbalta on concentration and mental fatigue found a modest improvement in concentration and fatigue. Another presentation compared the effectiveness and safety of Cymbalta versus other drugs used to treat fibromyalgia, including Lyrica and milnacipran. This was accomplished through applying statistics to 30 previously published clinical trials studying various fibromyalgia treatments. The authors concluded that there were no significant differences in the comparison of safety and efficacy of Cymbalta versus Lyrica and milnacipran.


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    So, what drug to use in the treatment of fibromyalgia? This is where many say trial and error come into the picture in the treatment of fibromyalgia.


    I prefer to think of this as plying the art of medicine.

    Finally, it was nice to stop by the National Fibromyalgia Association booth at the meeting. I asked the two nice ladies working the booth whether Karen Lee Richards was in attendance. Unfortunately, she was unable to make the meeting.


    I can say that they both spoke highly of her and her accomplishments.


    I encourage readers to check out the Association. They have much to offer those with the chronic pain of fibromyalgia.


Published On: November 21, 2008