Emerging therapies for fibromyalgia: an update

Abstract

Importance of the field: Fibromyalgia syndrome (FMS) is currently perceived by rheumatologists and pain physicians alike as representing the classic condition of central sensitization. This term has come to denote a condition in which chronic, widespread pain is attributed mainly to an increase in the processing and handling of pain by the CNS. Thus, effective treatment of the pain of FMS must be directed at the function of the CNS. Over recent years, the pharmacological industry has focused increasing attention on this syndrome, leading to the recent approval of three first medications specifically indicated in the treatment of FMS (i.e., pregabalin, duloxetine and milnacipran). Nonetheless, treatment of FMS remains challenging and in many cases incompletely successful. Issues with drug compliance and side effects, as well as limitations of intrinsic effectiveness, hamper the outcome in many cases. Thus, FMS continues to pose a significantly unmet medical need.

Areas covered in this review: In the current review, we attempt to update readers on novel developments in the FMS over the last 2 years. We include a discussion of the various pharmacological classes of medications which appear to be of promising potential in this area, including sodium oxybate, dopamine agonists, naltrexone, novel anticonvulsive medications, synthetic cannabinoids, NMDA antagonists and others.

What the reader will gain: Readers of this review will gain a glimpse into upcoming pharmacological directions in the management of FMS as well as attain an understanding of the mechanisms and pathophysiological pathways which are currently considered targets for drug development in FMS.

Take home message: Following the introduction of three medications specifically indicated in the management of FMS over the last 4 years, additional research is actively leading towards the introduction of new drugs aimed at improving symptoms related to pain and sleep in FMS. Physicians involved in the treatment of FMS patients are required to keep up-to-date on these promising avenues of progress and to be ready to incorporate them into clinical use.

Keywords::

• cannabinoid agonists
• dopamine agonists
• fibromyalgia
• sodium oxybate
• α₂δ ligands