Philip J. Mease, MD

blood biomarkers to assist with diagnosing fibromyalgia, as well as other imaging modalities.

Future Developments in Fibromyalgia Treatment

This is a video synopsis/summary of a panel discussion involving Philip J. Mease, MD.

Despite progress in approved medications for fibromyalgia, there are significant unmet needs, such as lack of awareness among patients and clinicians. Education dissemination is crucial to bridge this gap. Additionally, the field anticipates advancements in new therapies, driven by ongoing pain research to unravel pain mechanisms and identify treatment targets. Philip J. Mease, MD, expresses hope for a future with additional treatments beyond the current pharmacological options. Advancements in diagnostic biomarkers, including blood biomarkers to distinguish fibromyalgia from autoimmune diseases, and improvements in neuroimaging for better identification of affected individuals, are also anticipated. These developments hold promise for enhancing understanding and addressing the complexities of fibromyalgia. The speaker emphasizes the importance of these future prospects in advancing fibromyalgia care.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

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Philip J. Mease, MD, highlights the potential of blood biomarkers to assist with diagnosing fibromyalgia, as well as other imaging modalities.

treatment selection in fibromyalgia, highlighting combination therapy as well as the importance of a holistic approach to care.

Clinical Pearls for Clinicians Treating Fibromyalgia

Fibromyalgia may raise concerns for physicians regarding time consumption and emotional burden. Addressing these concerns requires upfront communication, explaining the neurobiology behind fibromyalgia to reduce stigma, particularly associated with psychological perceptions. With improved treatment approaches, managing fibromyalgia becomes more rewarding, especially when patients respond well to their treatment regimen. When patients have comorbid conditions, such as autoimmune diseases like rheumatoid arthritis or lupus, it's crucial to control both conditions concurrently. Employing current medications, biologics, and targeted synthetic disease-modifying drugs to manage inflammation and symptoms is essential. Simultaneously, acknowledging the presence of central sensitization or fibromyalgia is vital, fostering acceptance through patient-friendly language. Using terms like "central sensitization" can mitigate the stigma around fibromyalgia. Collaboratively pursuing nonpharmacological approaches alongside prescribed treatments enhances patient acceptance and makes the overall treatment approach more rewarding for both the physician and the patient.

Philip J. Mease, MD, discusses treatment selection in fibromyalgia, highlighting combination therapy as well as the importance of a holistic approach to care.

Treatment selection in fibromyalgia, highlighting combination therapy as well as the importance of a holistic approach to care.

Treatment Selection in Fibromyalgia

When introducing medications for fibromyalgia, choosing the appropriate one involves considering patient experiences and individual symptoms. For instance, if a patient emphasizes debilitating fatigue alongside pain, Milnacipran might be a preferred option due to its efficacy in addressing fatigue. However, patient-specific factors, such as high blood pressure concerns, may guide the selection of alternative medications like duloxetine or pregabalin.

Trial and error play a significant role in finding the most effective treatment, with adjustments based on symptom relief and tolerance of potential side effects. Combining medications, such as a small dose of pregabalin with an SNRI (serotonin and norepinephrine reuptake inhibitors) like duloxetine or milnacipran, is a strategy to simultaneously inhibit neuropeptides in the ascending pain pathway and boost the inhibitory side of pain signaling, potentially reducing side effects.

Beyond pharmacological interventions, a holistic approach to fibromyalgia care is crucial. This encompasses psychological counseling, regular conditioning exercises (such as swimming, which has shown benefits for musculoskeletal symptoms and fatigue), and improved sleep hygiene. Encouraging patients to explore alternative paths to physical activity, like swimming, emphasizes the importance of tailoring treatments to individual preferences and circumstances. In summary, comprehensive fibromyalgia care involves a thoughtful combination of medication management and multidisciplinary strategies to address the diverse aspects of this complex condition.

An expert rheumatologist reviews the efficacy and safety of the 3 FDA-approved therapies for treating fibromyalgia—pregabalin, duloxetine, and milnacipran.

FDA-Approved Therapies for Fibromyalgia

Effective management of fibromyalgia involves a spectrum of medications targeting symptoms like sleep disturbances and pain. Tricyclic antidepressants, utilized historically, demonstrated efficacy in improving sleep and ameliorating pain. However, their limited dosage capacity due to adverse events prompted the exploration of newer alternatives. Presently, 3 FDA-approved medications stand out for fibromyalgia treatment. Pregabalin, a notable contender, functions by limiting neuropeptides in the ascending nociceptive pathway, including GABA and substance P, which are excessively present in the central nervous system.

Additionally, 2 drugs, duloxetine and milnacipran, have gained approval for their ability to enhance serotonin and norepinephrine signaling in the descending pathways of the central nervous system. This dual action not only diminishes pain but also brings about improvements in sleep and fatigue. Significantly, these newer medications boast better tolerance compared to their tricyclic predecessors, marking a positive stride in fibromyalgia pharmacotherapy.

An intriguing study explored the combination of milnacipran and pregabalin, revealing an additive effect without an increase in adverse events. This finding suggests a potential avenue for combination therapy to enhance therapeutic benefits while minimizing unwanted effects. Precautions, however, are essential, particularly concerning potential interactions with antidepressants. Excessive serotonin effects may arise when combining these medications, necessitating a collaborative approach with other healthcare providers. This underscores the importance of interdisciplinary communication to tailor treatments and optimize patient care. In essence, these medications play a pivotal role in addressing the complex challenges faced by fibromyalgia patients, addressing not only pain but also encompassing improvements in physical function, cognition, fatigue, and overall patient well-being.

Philip J. Mease, MD

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