Potential drug therapies for the treatment of fibromyalgia

ABSTRACT

Introduction: Fibromyalgia (FM) is a common, complex chronic widespread pain condition is characterized by fatigue, sleep disturbance and cognitive dysfunction. Treatment of FM is difficult, requiring both pharmacological and non-pharmacological approaches, with an empiric approach to drug therapy focused toward individual symptoms, particularly pain. The effectiveness of current medications is limited with many patients discontinuing use.

Areas covered: A systemic database search has identified 26 molecular entities as potential emerging drug therapies. Advances in the understanding of the pathophysiology of FM provides clues to targets for new medications. Investigation of bioamine modulation and α2δ ligands and novel targets such as dopamine receptors, NMDA receptors, cannabinoid receptors, melatonin receptors and potassium channels has identified potential drug therapies.

Expert opinion: Modest improvement of health status in patients with FM has been observed with drugs targeting a diverse range of molecular mechanisms. No single drug, however, offered substantial efficacy against all the symptoms characteristic of FM. Identification of new and improved therapies for FM needs to address the heterogeneity of the condition, which suggests existence of patient subgroups, the relationship of central and peripheral aspects of the pathophysiology and a requirement of combination therapy with drugs targeting multiple molecular mechanisms.

KEYWORDS:

• Fibromyalgia
• clinical trials
• central sensitization
• pain
• fatigue
• cognitive dysfunction

Article highlights

• Effectiveness of current pharmacological treatments is limited with many patients discontinuing use.

• Several drugs with diverse mechanisms of action are being investigated as potential treatment approaches.

• The current and potential drugs primarily focus on suppression of central neuronal hyper-excitability.

• Modest efficacy has been reported for a few drugs against selective symptoms such as pain, anxiety and depression.

• Although primary focus has been towards modulation of bioamines and of the α2δ subunits of neuronal calcium channels, drugs acting on novel targets such as cannabinoid receptors, melatonin receptors and potassium channels are being investigated.

This box summarizes key points contained in the article.

Declaration of interest

K Lawson has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.