Since the cause and pathophysiology of fibromyalgia (FM) remain unknown, treatment is often limited; fewer than 50% of patients have significant and sustained clinical improvement. No pharmacologic agent are indicated specifically for FM treatment, although many have been tried to date. Controlled trials with non-steroidal anti-inflammatory drugs have been shown them to be of little help, despite their use in a majority of patients. Steroidal anti-inflammatory drugs are not efficacious and often deleterious. Among analgesics, preliminary data suggest that tramadol, affecting norepinephrine at the receptor site, may be useful for FM pain. No clinical data are available to suggest efficacy of opioids in FM. Tricyclic antidepressants and selective serotonin reuptake inhibitors may diminish the sleep disturbance, pain and depression associated with FM. they remain the cornerstone of drug therapy in FM. Blockade of the serotonin receptor subtype 5-HT3 with Tropisetron or Ondansetron has been reported to significantly decrease the number of tender points, despite poor digestive tolerance. The findings of low levels of insulin-like growth factor 1 in FM led to give daily growth hormone (GH) injections to 22 women (vs placebo to 23), enrolled in a controlled study. A 9 months, the tender point score was significantly improved with GH. other agents like 5-hydroxytryptophan, gamma-hydroxybutyrate and S-adenosyl-L-Methionine also shown promising results. FM symptoms may be alleviated in a short term manner with various pharmacologic treatments but a minority of patients still experience remission at a few years follow-up.
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