Actualización en el tratamiento de la fibromialgia hecho por estudiantes de la rotación de Reumatologia de la Universidad del Norte en Barranquilla, Colombia
1. FIBROMYALGIA: TREATMENT UPDATE Carolina P. Idrovo T. Carolina Maestre G. Universidad del Norte Barranquilla Rotación de Reumatología Tutor: Carlo Vinicio Caballero Uribe MD.
6. TERAPIA FARMACOLÓGICA Arnold, L. The Pathophysiology, Diagnosis and Treatment of Fibromyalgia. Psychiatr Clin North Am .2010; 33(2): 375-408 PAUTA TERAPIA NO FAMACOLOGIACA FARMACOLÓGICO AMERICAN PAIN SOCIETY (APS) FV: Educación, ejercicio aerobico, terapia multidisciplinar MV: Entrenamiento de la fuerza, hipnoterapia FV: Amitriptilina 25-50mg/día; ciclobenzapina 10-30mg/día MV: Milnaciprán, duloxetina; ISRS (Fluoxetina 20-80mg/d) LIGA EUROPEA CONTRA EL REUMATISMO (EULAR) GB: Balneoterapia GC: Fisioterapia, rehabilitación, relajación GD: CBT GA: Antidepresivos (Amitriptilina, duloxetina, fluoxetina) pregabalinal tramadol GD: Analgésico (paracetamol)
7. Arnold, L. The Pathophysiology, Diagnosis and Treatment of Fibromyalgia. Psychiatr Clin North Am .2010; 33(2): 375-408
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10. PREGABALIN + MILNACIPRÁN Farmer, M; et al. Efficacy of milnacipran when added to pregabalin in the management of fibromyalgia: A randomized, open-label, controlled study. Ann Rheum Dis. 2010; 69:448. Durante un ensayo abierto, se tomaron 351 pacientes Con FM que mostraron una pobre respuesta a la monoterapia con Pregabalin (300-450mg/día) Durante 12 semanas se les añadió Milnaciprán (100 mg/día) a su régimen terapéutico previamente constituido por Pregabalín Resultados: Los pacientes mostraron un descenso de 20 puntos en una escala de dolor de 100 puntos después de añadir Milnaciprán a su régimen terapéutico. También se alcanzaron menos efectos secundarios de los dos fármacos, y se hizo factible utilizarlos a dosis más bajas para obtener el mismo efecto.
Tramadol is a centrally acting opiate receptor agonist and a monoamine reuptake inhibitor that may exert Antinociceptive effects within the ascending and descending pain pathways.9 A multicenter, double-blind, randomized, placebo-controlled, A multicenter, double-blind, randomized, placebo-controlled, 91-day study examined the efficacy of the combination of tramadol (37.5 mg) and acetaminophen (325 mg) in 315 patients with FM. Patients taking tramadol and acetaminophen (4 1.8 tablets/d) were significantly more likely than placebo-treated subjects to continue treatment and experience an improvement in pain and physical function.
The analgesic action of both drugs is believed to be mediated through binding to the alpha-2-delta (a-2-d) protein, an auxiliary subunit of voltage-dependent calcium channels, and modulating the influx of calcium ions into Hyperexcited neurons, and thereby reducing the synaptic release of several neurotransmitters believed to play a role in pain processing, including glutamate and substance P.18 Pregabalin dosed at 150 mg twice a day, 225 mg twice a day, and 300 mg twice a day, has a durable effect for maintaining patient’s improvement in pain associated with FM as well as in measures of global assessment, sleep, fatigue, and functional status in those who respond to pregabalin
