Fibromyalgia Syndrome's New Paradigm: Neural Sensitization and Its Implications for Treatment

Objectives: To provide fibromyalgia syndrome [FMS] specialists with an overview of information suitable for the education of primary care physicians about current understanding of the mechanism of and treatments for FMS. Findings: Controlled studies using functional magnetic resonance imaging and other objective markers document FMS as a disorder of increased sensitivity of the central nervous system's pain signaling pathways. This "neural sensitization" model shifts the focus for treatment toward drugs that affect neural pathways. New options include: 5-hydroxytryptamine serotonin receptor antagonists such as odansetron [Zofran], N-methyl-D-aspartate receptor antagonists such as Ketamine, growth hormone stimulants such as pyridostigmine [Mestinon], anti anti-seizure drugs Such as gapapentin [Neurontin] or pregabalin [Lyrica], ganima hydroxy butyrate-related agonists such as sodium sodium oxybate [Xyrem], and the new serotonin-norepinephtine reuptake inhibitors-c lass antidepressants such as duloxetine [Cymbalta] and milnacipran. Also recommended is appropriately graded exercise, i.e., conditioning, work on sleep quality, and cognitive behavioral therapy to support coping skills. Conclusion: Improved understanding of the neural mechanisms involved in FMS and new options for treatment make it imperative that FMS specialists reach out to educate their primary care physician colleagues.