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Pharmacotherapy for Fibromyalgia Case Study

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Updated: Apr 9th, 2022

Introduction

Fibromyalgia is a musculoskeletal disorder that causes widespread pains in patients. Patients also experience fatigue, dizziness, soft tissue tender points, memory loss and mood changes. Medical experts argue that fibromyalgia amplifies the way an individual senses pain by altering the processing of pain signals (Amand & Marek, 2003). They attribute the pain to physical trauma, medical operations, infections and prolonged stress.

Some patients may experience long-term headaches, irritable bowels, lack of sleep, depression, muscle stiffness and anxiety. Research shows that women are more vulnerable to fibromyalgia compared to their male counterparts. This disorder is not curable, but medics have come up with various medications that can help prevent the symptoms from intensifying (Arcangelo & Peterson, 2013, pp. 556).

Causes of Fibromyalgia

Scientists have never found the main cause of fibromyalgia. However, many of them suspect defects in the pain mechanism of the body, problems in the central nervous system and abnormalities in muscles. These three conditions may result from stress, injuries, child delivery, operations and the loss of close friends or fiancés through death or separation (Arcangelo & Peterson, 2013, pp. 560).

According to Arcangelo and Peterson, there are eighteen parallel points in the muscles of human beings that medical experts use when testing for tender points. They include the occiput, the lower cervical spine, the Trapezius muscle, the supraspinatus process and the second rib at the costochondral junction. The remaining points include the lateral epicondyle, the gluteal muscle, the greater trochanter and the knee (2013). Medical experts start suspecting that their patients are suffering from FM when they notice pains in eleven of these points.

Vulnerable Groups

Fibromyalgia can affect anybody. In the US, approximately eight million citizens suffer from FM. However, research indicates that women are more susceptible to fibromyalgia compared to men. Medical practitioners have diagnosed twice as many women as their male counterparts. FM mostly affects people between twenty and forty years (Arcangelo & Peterson, 2013, pp. 561).

Diagnosis

Medical practitioners identify FM when their patients complain of widespread aches, pains in the axial skeleton and aches and tremors in at least eleven tissues points. Patients also experience stiffness, lack of sleep, depression and anxiety (Arcangelo & Peterson, 2013).

Treatment of Fibromyalgia

Medical research has not found a drug that can cure fibromyalgia. However, experts have developed some good methods of suppressing its symptoms. These methods focus on regulating the pains that result from FM. They counter insomnia and suppress depression and anxiety.

The first method of medication is the use of low doses of Tricyclic Antidepressants. Antidepressants suppress pain, fatigue, insomnia and stiffness by preventing the reuptake of norepinephrine and serotonin. Drugs that work in this manner include nortriptyline, amitriptyline and doxepin (Arcangelo & Peterson, 2013).

Duloxetine and milnacipran are also very effective in suppressing FM symptoms. They work as Dual Neurotransmitter Reuptake Inhibitors. They alter the processing of pain by the neuroendocrine system (Arcangelo & Peterson, 2013).

Combining TCA with Selective Serotonin Reuptake Inhibitor is also very effective in dealing with FM symptoms. SSRI eliminates the depression that results from FM while TCA counters the effects of SSRI on sleep. The commonest SSRI is fluoxetine (Arcangelo & Peterson, 2013).

Gabapentin and pregabalin are also common in dealing with FM. They reduce pain and stiffness by preventing the release of neurotransmitters (Arcangelo & Peterson, 2013). Relaxers of the skeletal muscles also help in suppressing the symptoms of FM by hindering the noradrenergic function of the brain stem. They also hinder the efferent activity of motor neurons. This process reduces pain and stiffness (Drugs.com, 2014). Narcotic analgesics also reduce FM aches. However, medical practitioners advise patients to use them only for short periods, especially when other drugs fail to work or while trying to adjust the treatment.

Effects of Gender on the Effectiveness of the Drugs

Gender has a great impact on the prevalence of fibromyalgia. About 66% of the cases of fibromyalgia are women while only 34% are men. As Laurie Edward reports, “Women have hormonal cycles, smaller organs, higher body fat composition-all of which play a role in how drugs affect our bodies” (2013). He goes further to assert that women metabolize antibiotics and antianxiety drugs faster than men do. However, most of the drugs that deal with FM symptoms are not safe for use by pregnant and lactating women. Therefore, women should tell their doctors about their pregnancy before medication (Laureate Education, 2012).

Reducing the Side-effects of Drugs

  • Patients should take their drugs with food to avoid nausea
  • Sucking sugarless candies can also help prevent nausea
  • Drinking enough water can also help avoid nausea
  • Reducing the amount of sugary foods can help avoid adding weight
  • They should also have sex before taking drugs because some drugs reduce the urge for sex
  • Asking the doctor to prescribe an antidepressant that brings back the urge for sex
  • Taking a siesta during the day may reduce drowsiness
  • The patient can also reduce drowsiness by being active throughout the day
  • Taking antidepressants in the morning effectively deals with insomnia
  • Patients should also avoid caffeine in the evenings to avoid insomnia (Drugs.com, 2014)

Conclusion

FM is a disorder that causes pain in many parts of the body. FM has no cure, but various treatments can reduce the pain and psychiatric problems that result from it. It is more prevalent in women than in men. Most of the drugs that treat FM are not safe for pregnant women, and medical practitioners should use them with care.

References

Amand, R. & Marek, C. (2003). What your doctor may not tell you about fibromyalgia fatigue (1st Ed.). New York, NY: Warner Books.

Arcangelo, V. & Peterson, A. (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd Ed.). Ambler, PA: Lippincott Williams & Wilkins. (pp. 560–567).

Drugs.com (2014). Prescription drug Information, interactions & side effects. Web.

Edwards, L. (2013). Women and the treatment of pain. New York Times. Web.

Laureate Education, Inc. (2012). Advanced pharmacology – Mid-course review. Baltimore, MD: Author.

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