Neoteric pharmacotherapeutic targets in fibromyalgia

Abstract

Introduction: Fibromyalgia is a debilitating, chronic pain disorder typically present with allodynia and hyperalgesia. Estimates from the USA suggest that fibromyalgia affects about 5% of women, and is the third most common rheumatic disorder after lower back pain and osteoarthritis. Recent research advances highlighted a role for aberrant central pain processing in fibromyalgia, and consistent with this, the first three drugs (pregabalin, duloxetine and milnacipran) approved by the FDA for fibromyalgia over the past 2 years have a predominantly central mode of action. Despite progress in understanding of fibromyalgia and the long-awaited introduction of three medications for treating it, fibromyalgia continues to pose a significantly unmet medical need, negatively affecting the lives of millions of individuals worldwide in all ethnic groups and all economic classes.

Areas covered: Prevailing theories of pathogenesis of fibromyalgia, existing therapies and the potential of current research on novel targets.

Expert opinion: Current research on novel sedative–hypnotics, anti-epileptic medications, various reuptake inhibitors, growth hormone agonists, canabinoid agonists, non-opiate analgesics and 5-HT₃ antagonists offers hope for the the next generation of therapeutic options for fibromyalgia. With regards to the development of novel pharmacotherapies, there seem to be grounds for increased optimism regarding prospective treatments of the disorder.

Keywords:

• central sensitization
• fibromyalgia
• pathogenesis, pharmacotherapy