On Pain's Trail (by Shari Roan of the L.A. Times) explains some of these recent breakthroughs in laymen's terms, shares the personal story of an FMS sufferer, and provides a glimpse at the insulting skepticism those of us with FMS often encounter.
It also sexes up "tender points." I don't think I've seen this chart at my doc's office.
I recommend reading the article, but if you don't feel like it, here are some of the most interesting parts:
For years doctors had been looking for a cause of fibromyalgia at the site of the pain: the head, back, hands, neck, gut or elsewhere. And their treatments focused on soothing pain in these locations. As their understanding has grown, however, these treatments have begun to change and new ones are in development.
Fibromyalgia is now thought to arise from miscommunication among nerve impulses in the central nervous system, in other words the brain and spinal cord. This "central sensitization" theory is described in detail this month in a supplement of the Journal of Rheumatology. The neurons, which send messages to the brain, become excitable, exaggerating the pain sensation, researchers have found.
As a result, fibromyalgia patients feel intense pain when they should feel only mild fatigue or discomfort — such as after hauling bags of groceries. They sometimes feel pain even when there is no cause.
The "central sensitization" theory may be the common link between FMS and several other mysterious conditions, including irritable bowel syndrome, gulf war syndrome, and endometriosis. According to the article, doctors hope that breakthroughs in FMS research will help them understand these diseases as well.
The article also speculates that Fibromyalgia drugs may be available as early as 2006, and includes a list of half a dozen promising drugs being studied. Greater understanding of physiological abnormalities in FMS sufferers has paved the way.
Recent studies show multiple triggers for the amped-up response to pain. Fibromyalgia patients have, for instance, elevated levels of substance P, a neurotransmitter found in the spinal cord that is involved in communicating pain signals.
They also appear to have lower levels of substances that diminish the pain sensation, such as the brain chemicals serotonin, norepinephrine and dopamine. Growth hormone, which helps promote bone and muscle repair, is also found in lower levels in fibromyalgia patients.
New therapies are aimed at these abnormalities.
The drugs and what they do:
• Pregabalin (brand name Lyrica): This antiepileptic drug, also approved for diabetic nerve pain, appears to be effective in reducing pain and disturbed sleep in fibromyalgia patients. If late-stage trials prove successful, Pfizer plans to ask the FDA to approve the drug for fibromyalgia.
• Milnacipran: Marketed outside the United States as an antidepressant, this drug increases the brain chemicals norepinephrine and serotonin. Early studies showed it to be successful in reducing fibromyalgia pain, and data from the first phase-three trial is due out this fall. Cypress Bioscience and Forest Laboratories hope to seek FDA approval late next year.
• Duloxetine (brand name Cymbalta): This antidepressant, already on the market, increases the activity of serotonin and norepinephrine. It was successful in reducing fibromyalgia pain in early-phase studies, and plans for a phase-three study are underway. If successful, Lilly may seek FDA approval of the medication for fibromyalgia.
• Xyrem: Approved for narcolepsy with the complication of weak or paralyzed muscles, the drug might be able to increase deep sleep in people with fibromyalgia. The results of an initial study on fibromyalgia are due later this year. It's made by Jazz Pharmaceuticals.
• Provigil: Approved for daytime sleepiness associated with narcolepsy and shift-work disorders, or sleep problems in those who work nights or on changing schedules, the medication might help treat fatigue related to fibromyalgia. The manufacturer, Cephalon Inc., has no plans to seek approval for the drug for this purpose, but it can be used off-label.
• Mirapex: Approved for Parkinson's disease, this drug works by increasing the neurotransmitter dopamine. The manufacturer, Boehringer Ingelheim, has no plans to study the drug for use in fibromyalgia, but it can be used off-label. An independent study showed it was promising for reducing fibromyalgia pain.