YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==FIBROMYALGIA TREATMENTS== 23 AUTHOR Miller DR AUTHOR Seifert RD TITLE Management of fibromyalgia, a distinct rheumatologic syndrome SOURCE Clin. Pharm.; VOL 6 ISS Oct 1987, P778-786, (REF 61) ABSTRACT IPA COPYRIGHT: ASHP The pathophysiology and management of fibromyalgia (fibrositis), a unique nonarticular rheumatologic syndrome characterized by diffuse musculoskeletal aches and pains, stiffness, discrete tender points at typical soft-tissue sites, and a characteristic sleep disturbance, are reviewed. The pathology of fibromyalgia is unknown but appears to involve complex interactions of central neurotransmitters with a relationship to pain perception, mood, and sleep. Treatment is empirical; nondrug treatment involving education, relaxation, and increased physical activity is essential. Few controlled trials of drug therapy have been conducted. Analgesics, anti-inflammatory drugs, phenothiazines, tricyclic antidepressants, and the tricyclic muscle relaxant cyclobenzaprine hydrochloride (Flexeril; I) have been used; low doses of amitriptyline or I provide increased control of pain and mood. 3 AUTHOR Godfrey RG TITLE A guide to the understanding and use of tricyclic antidepressants in the overall management of fibromyalgia and other chronic pain syndromes. SOURCE Arch Intern Med; VOL 156, ISS 10, 1996, P1047-52 (REF: 44) ABSTRACT The purpose of this review is to present relatively detailed information on the characteristics of tricyclic antidepressants, mainly amitriptyline hydrochloride and doxepin hydrochloride, for use as an integral part of the safe and effective management of fibromyalgia and, to a lesser extent, other chronic pain syndromes. Data sources include MEDLINE searches in English, relevant reference books and textbooks, my personal database and library, as well as personal clinical experience. I discuss these data with regard to the pharmacologic characteristics, mechanisms of action, adverse effects, and precautions involved with the use of tricyclic antidepressants. Additional information is given on drug selection and dosage titration. Much emphasis is placed on the fact that while tricyclic antidepressants play a major role in the management of fibromyalgia and other chronic pain syndromes, lifestyle alterations (eg. physical reconditioning and exercise), as well as behavior modification, are also vital to a successful outcome in management. 10 AUTHOR Waylonis GW AUTHOR Ronan PG AUTHOR Gordon C TITLE A Profile of Fibromyalgia in Occupational Environments SOURCE American Journal of Physical Medicine and Rehabilitation, Vol. 73, No. 2, pages 112-115, 22 references, 1994 ABSTRACT The relation between occupational activities and fibromyalgia was examined. Questionnaires were completed by 321 fibromyalgic patients from across the United States and Canada. Questions regarded effects of current and past occupations on their fibromyalgia. The major occupations of the participants were general office workers (20%), health care providers (14%), and educators (11%). Twenty four of the 46 health professionals were registered nurses. Major occupational activities reported as aggravating factors in fibromyalgia included computer and/or typing (37%), prolonged sitting (37%), prolonged standing and walking (27%), stress (21%), heavy lifting or bending (19%), and repeated moving and lifting (18%). Occupational activities reported as not aggravating fibromyalgia symptoms included walking (19%) and variable light sedentary work (15%). Patients with fibromyalgia reported that they did not tolerate prolonged repetitive activities, particularly under high stress or in uncomfortable climatic conditions. The occupations best tolerated by individuals with fibromyalgia appeared to be those that involved the performance of light sedentary activities with job task rotation during the work day. 11 AUTHOR Carette S AUTHOR Bell MJ AUTHOR Reynolds WJ AUTHOR Haraoui B AUTHOR Guimont C AUTHOR et al TITLE Comparison of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia SOURCE Arthritis Rheum.; VOL 37 ISS Jan 1994, P32-40, (REF 34) ABSTRACT IPA COPYRIGHT: ASHP A multicenter, double-blind controlled study was conducted to evaluate the therapy of fibromyalgia in 280 patients, ages 18 yr or older, who received amitriptyline, cyclobenzaprine, or placebo for 6 months. After 1 month of treatment, 21% of patients given amitriptyline and 12% of patients given cyclobenzaprine had significant improvement, compared with none of the patients in the placebo group. These percentages increased to 36%, 33%, and 19%, respectively, at 6 months. The nature and frequency of side effects reported by patients in each group were similar. It was concluded that these 2 drugs differ little in terms of efficacy and side effects in patients with fibromyalgia, and both were more effective than placebo in short term treatment. 14 AUTHOR Fossaluzza V AUTHOR De Vita S TITLE Combined therapy with cyclobenzaprine and ibuprofen in primary fibromyalgia syndrome SOURCE Int. J. Clin. Pharmacol. Res.; VOL 12 ISS 2 1992, P99-102, (REF 10) ABSTRACT IPA COPYRIGHT: ASHP An open randomized study of the effects of oral cyclobenzaprine alone and combined with ibuprofen was conducted in 32 female patients (ages 23-52 yr) with primary fibromyalgia syndrome (PFS) who received 10 mg cyclobenzaprine alone or with 600 mg ibuprofen at night for 10 days. Assessment of efficacy included the number of tender points, muscle tightness, sleep difficulty, pain intensity and duration of morning stiffness. At the end of the study, symptoms were improved to the same extent in both groups. The exception was morning stiffness, which was significantly more reduced in patients receiving both drugs. No patient discontinued therapy due to side effects. It was concluded that cyclobenzaprine combined with ibuprofen is safe and effective in relieving the discomfort of PFS. 16 AUTHOR Russell IJ AUTHOR Fletcher EM AUTHOR Michalek JE AUTHOR McBroom PC AUTHOR Hester GG TITLE Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam: double blind, placebo controlled study SOURCE Arthritis Rheum.; VOL 34 ISS May 1991, P552-560, (REF 39) ABSTRACT IPA COPYRIGHT: ASHP Ibuprofen 600 mg 4 times a day plus alprazolam 0.5-3.0 mg at bedtime was compared to either drug plus placebo or placebo therapy in 78 patients with fibrositis/fibromyalgia syndrome. Dolorimeter Score, Tender Point Index, patient self-assessment and physician global perception were used as therapeutic indicators. Tender Point Index and patient assessment were significantly different among the groups receiving ibuprofen and/or alprazolam and those receiving placebo. Fifteen patients failed to complete the 8 wk trial, with 6 withdrawing due to side effects. It was concluded that ibuprofen plus alprazolam has potential benefit for the treatment of fibromyalgia. 17 AUTHOR Tyber MA TITLE Lithium carbonate augmentation therapy in fibromyalgia SOURCE Can. Med. Assoc. J.; VOL 143 ISS Nov 1 1990, P902-904, (REF 15) ABSTRACT IPA COPYRIGHT: ASHP Three cases are described in which female patients (ages 48, 49 and 56 yr) were treated with 300 mg lithium carbonate 3 or 4 times daily for fibromyalgia. All 3 patients experienced a prompt and marked reduction of pain and stiffness that was sustained. Two of the patients enjoyed pain-free days for the first time since the onset of symptoms and one had minimal pain 18 months after the discontinuation of therapy. Laboratory tests showed no evidence of lithium toxicity to the thyroid or kidney and no goiters were noted. 18 AUTHOR Finestone DH AUTHOR Ober SK TITLE Fluoxetine and fibromyalgia SOURCE JAMA; VOL 264 ISS Dec 12 1990, P2869-2870, (REF 5) ABSTRACT IPA COPYRIGHT: ASHP The successful therapy of fibromyalgia in 2 female patients, aged 41 and 49 yr, who were treated with fluoxetine hydrochloride (Prozac), 20 mg/day for 3 months and one month, respectively, is reported. One patient required additional therapy with 50 mg/day doxepin hydrochloride for nighttime nervousness attributed to fluoxetine hydrochloride. It was suggested that the mechanism by which fluoxetine acts in fibromyalgia may be due to augmentation of serotonin, a neurotransmitter involved in the regulation of mood, restorative sleep, and sensitivity to pain. 20 AUTHOR Fisher P AUTHOR Greenwood A AUTHOR Huskisson EC AUTHOR Turner P AUTHOR Belon P TITLE Effect of homeopathic treatment on fibrositis (primary fibromyalgia) SOURCE Br. Med. J.; VOL 299 ISS Aug 5 1989, P365-366, (REF 5) ABSTRACT IPA COPYRIGHT: ASHP A double blind, placebo controlled, crossover study of the therapy of fibromyalgia in 30 patients, who were treated with a homeopathic preparation of Rhus toxicodendron administered as an oral tablet, is reported. The patients did better in all variables measured when they took active treatment rather than placebo.