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Chronic widespread pain and a heightened and painful response to pressure. Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness.

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Nerves which have been damaged by injury or disease can continue to produce pain. This type of pain is called neuropathic pain. Some antiepileptic medications can help neuropathic pain. Phenytoin is an antiepileptic medication, and the aim of this review was to assess how effective phenytoin is for neuropathic pain and fibromyalgia. We identified no good quality studies of phenytoin used in this situation. When used to treat epilepsy, phenytoin can cause potentially troublesome adverse events, affecting nervous tissue, the blood, and unborn children. Based on current evidence, phenytoin cannot be recommended for treating neuropathic pain. Other antiepileptic drugs such as pregabalin, gabapentin, and carbamazepine have been shown to be of value in neuropathic pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 16, 2012

Nerves which have been damaged by injury or disease can continue to produce pain. This type of pain is called neuropathic pain. Some antiepileptic medications can help neuropathic pain. Clonazepam is an antiepileptic medication, and the aim of this review was to assess how effective clonazepam is for neuropathic pain and fibromyalgia. We identified no good quality studies of clonazepam used in this situation. Dependence and tolerance may occur with prolonged use, although it is less of a problem with clonazepam than many other drugs from the same class (benzodiazepines), and behavioural disinhibition has been reported in a few patients with psychiatric problems. Based on current evidence, clonazepam cannot be recommended for treating neuropathic pain. Other antiepileptic drugs such as pregabalin, gabapentin, and carbamazepine have been shown to be of value in neuropathic pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 16, 2012

How do drugs for fibromyalgia compare in improving symptoms?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: June 12, 2011

Research has suggested that traditional Eastern practices such as tai chi, qigong and yoga can relieve fibromyalgia symptoms. There is no proof that other complementary or alternative treatments help. People who have fibromyalgia often try out a lot of different things to relieve their pain and cope better in everyday life. Some pin their hopes on complementary and alternative approaches, and turn to naturopaths or other alternative practitioners – especially if they have the feeling that doctors can't help them or don’t take them seriously. Complementary and alternative practitioners usually take more time for their patients. But people generally have to pay for these treatments themselves. Some people don’t believe in complementary and alternative medicine. One reason for this is that, for most of these treatments, there is no scientific explanation for how they would work. Whether or not a treatment works can still be tested in good-quality studies, though, even without knowing why they work. It's important to do good-quality studies because fibromyalgia symptoms come and go. This means that, if symptoms improve after using a certain treatment, that might just be a coincidence. In other words, the symptoms might have improved on their own anyway – especially because people tend to start treatments when their symptoms are particularly bad.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 21, 2018

Non‐malignant musculoskeletal pain is an increasing problem in western countries. Fibromyalgia syndrome is an increasingly recognised chronic musculoskeletal disorder. The main purpose of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for fibromyalgia and wide spread musculoskeletal pain among working age adults. Patients included in the controlled trials in this review ranged in age from 18‐65 years. Seven studies, with 1050 patients were included. The effectiveness of multidisciplinary rehabilitation was graded limited, showing no quantifiable benefit for both fibromyalgia and widespread musculoskeletal pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 26, 1999

If fibromyalgia really affects your quality of life and daily routine, and if other treatments aren’t effective enough, multimodal pain management is an option. Cognitive behavioral therapy helps you to recognize thoughts and behaviors that make the pain worse, and then try to change them. Chronic (long-term) pain can cause various problems, such as sleep problems and exhaustion. It can also greatly affect your physical fitness and affect all areas of your life, including your relationships, family life, work, household chores, hobbies and recreational activities. The pain often has an impact on your mood, too. Chronic pain can make people feel scared – for instance, scared of moving too much or worried that the symptoms will keep on getting worse and increasingly dominate their life. Some people then become withdrawn and lose hope that things will improve. If the anxiety becomes overwhelming, it’s easy to fall into a vicious cycle of fears, feeling down, pain, sleep problems, exhaustion and worsening symptoms. Because chronic pain can be caused by various things and affect many areas of life, it is often a good idea to use a combination of different treatments. This is where multimodal pain management comes in.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 8, 2018

Gentle physical exercise can relieve pain and tiredness in people with fibromyalgia. Relaxation and stress management techniques aim to help people become more aware of their bodies, recognize their own limitations and cope better with stress. Staying physically active is particularly important in fibromyalgia. That can be difficult if you’re always exhausted, though. Many people who have fibromyalgia avoid exercise because they’re afraid that it might be too much for them and make their symptoms worse. But studies have shown that gentle physical exercise can improve their fitness and wellbeing, and somewhat relieve the pain. If someone has already had fibromyalgia for a while and has been avoiding exercise because of the pain, it’s best for them to start doing very gentle exercises at first and then gradually increase the intensity. For instance, the goal may be to do low-intensity endurance training (e.g. Nordic walking, cycling, dancing or water aerobics) for 30 to 60 minutes two or three times a week. Gentle strength training exercises using weights, elastic exercise bands or exercise equipment can help too. Meditative forms of movement such as tai chi, qigong and gentle yoga styles are also an option. In Germany, statutory health insurers cover the costs of group functional training classes for people with fibromyalgia, for up to 24 months. Functional training involves simple gymnastic exercises or water exercises that are done under the instruction of a physiotherapist. Doctors can prescribe functional training using a special form, without it having a negative effect on their budget.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 8, 2018

Antiepileptic drugs like lacosamide are commonly used for treating neuropathic pain, usually defined as pain due to damage to nerves. This would include postherpetic neuralgia (persistent pain experienced in an area previously affected by shingles), painful diabetic neuropathy, nerve injury pain, phantom limb pain and trigeminal neuralgia; fibromyalgia also responds to some antiepileptic drugs. This type of pain can be severe and long‐lasting, is associated with lack of sleep, fatigue, depression and a reduced quality of life. This review included five studies in painful diabetic neuropathy (1863 participants) and one in fibromyalgia (159 participants). In people with painful diabetic neuropathy, lacosamide had only a modest effect, with a specific effect due to its use in 1 person in 10. This is a minor effect and may be an over‐estimate due to use of the last observation carried forward method for analysis. There was insufficient information in fibromyalgia to draw any conclusions about the effect of lacosamide. There was no significant difference between lacosamide and placebo for participants with any, or a serious, adverse event, but there were significantly more adverse event withdrawals with lacosamide. Regulatory authorities have not licensed lacosamide for treating pain based on evidence presently available.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 15, 2012

Neuropathic pain is pain coming from damaged nerves. It is different from pain messages carried along healthy nerves from damaged tissue (a fall, or cut, or arthritic knee). Neuropathic pain is treated by different medicines than pain from damaged tissue. Medicines like paracetamol or ibuprofen are not effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain. Our understanding of fibromyalgia (a condition of persistent, widespread pain and tenderness, sleep problems, and fatigue) is lacking, but fibromyalgia can respond to the same medicines as neuropathic pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 3, 2013

There is no good evidence to support or refute the suggestion that oxycodone, alone or in combination with naloxone, reduces pain in fibromyalgia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

There is no good evidence to support or contradict the suggestion that gabapentin at daily doses of 1200 to 2400 mg reduces pain in fibromyalgia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2018

In recent years there has been an increase in research on the causes and underlying mechanisms of fibromyalgia. It is currently thought that a combination of different factors play a role in the development of this disease. But it isn’t easy to do research on the causes and risk factors of fibromyalgia. One reason for this is that a lot of people who have fibromyalgia also have medical conditions such as rheumatoid arthritis, other pain disorders or mental health problems. So it isn’t clear whether their symptoms are being caused by fibromyalgia or something else. What’s more, a lot of the research results in this area aren’t fully reliable. This is because, for instance, the studies didn’t have enough people in them, or they didn’t have comparison groups or didn’t follow the participants for long enough.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 8, 2018

This summary of a Cochrane review presents what we know from research about the effect of MAOIs for fibromyalgia (FM).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 18, 2012

How do antiepileptics compare in treating bipolar disorder?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: October 1, 2010

‐ moderate intensity aerobic training for 12 weeks may improve overall well‐being and physical function; moderate intensity aerobic exercise probably leads to little or no difference in pain or tender points.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 17, 2007

The drugs amitriptyline, duloxetine, milnacipran and pregabalin can relieve fibromyalgia pain in some people. They may cause side effects such as a dry mouth or nausea. Normal painkillers like ibuprofen or acetaminophen (paracetamol) aren’t recommended for the treatment of fibromyalgia. There is currently no approved medication that was specifically developed for the treatment of fibromyalgia. But some medications that have been approved for the treatment of other types of chronic pain or diseases can help in fibromyalgia too. Studies have shown this to be true for the following drugs: amitriptylineduloxetinemilnacipranpregabalin With the exception of amitriptyline, when these drugs are used for the treatment of fibromyalgia, it is legally considered to be unapproved (off-label) use. Special regulations apply here, affecting things like whether health insurers cover the costs. This is different if someone who has fibromyalgia also has a medical condition for which the medication has been approved, such as depression. It can take several weeks for the medication to start working. It makes sense not to rely on medication alone, but instead combine it with other treatments. For instance, gentle physical exercise can relieve the symptoms and improve your resilience. The way you manage your life with the illness is important too – things like trying to reduce stress and planning your day to avoid overdoing it can help.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 8, 2018

We found very low‐quality evidence that oral non‐steroidal anti‐inflammatory drugs (NSAIDs) have no effect on pain or other symptoms in people with moderate or severe pain from fibromyalgia. Ibuprofen and diclofenac are common NSAIDs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 27, 2017

Duloxetine is a drug used to treat depression and urinary urge incontinence (leakage of urine) and it can be also be useful for certain types of pain. Pain can arise spontaneously when there is damage to nerves that carry pain information to the brain (neuropathic pain). When this damage is to nerves outside the spinal cord it is called a peripheral neuropathy. Another type of pain, nociceptive pain, occurs when the nerves sense damage to another tissue (for example, a pinprick in the skin). Some pain is of unclear origin and occurs without apparent nerve or tissue damage. This sort of pain happens, for example, in fibromyalgia. The objective of this review was to assess the benefits and harms of duloxetine for treating painful neuropathy and chronic pain of all sorts.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 3, 2014

Neuropathic pain is caused by nerve damage, often accompanied by changes in the central nervous sytem, and fibromyalgia is a related complex pain syndrome. Many people with these conditions are disabled with moderate or severe pain for many years. Conventional analgesics are usually not effective treatment options. In light of the fact that there are similarities between the pathophysiologic and biochemical mechanisms observed in epilepsy and in neuropathic pain, it is not surprising that antiepileptic agents can be used to treat neuropathic pain. The aim of this review was to investigate the efficacy and adverse events associated with use of sodium valproate and valproic acid for the treatment of chronic neuropathic pain and fibromyalgia. We identified three relevant studies, two in diabetic neuropathy and a third in post‐herpetic neuralgia. Two of the three studies report significantly greater reduction in pain for valproate than placebo, but studies were small (≤ 45 participants) and provided insufficient data for pooled analysis, and the methods of analysis used may have overestimated treatment effect. Adverse events such as nausea, sedation, drowsiness, vertigo, and abnormal liver function are more common with valproate than placebo, but these studies were unsuitable to allow for a comprehensive assessment of harm.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 5, 2011

We found high quality evidence that pregabalin at daily doses of 300 to 600 mg produces a large fall in pain in about 1 in 10 people with moderate or severe pain from fibromyalgia. Pain reduction comes with improvements in other symptoms, in quality of life, and in ability to function.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

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