Beyond Pills: Synergizing Pharmacological and Physical Activity Interventions in Fibromyalgia Treatment. A review
DOI:
https://doi.org/10.12775/QS.2024.19.53279Keywords
Fibromyalgia, Vortioxetine, Tapentadol, High-intensity interval training, Virtual Reality (VR) TherapyAbstract
Introduction and purpose
Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive impairment, affecting 2-4% of the global population, with a higher prevalence among women and those of lower socioeconomic status. The pathogenesis of FM is complex and multifactorial, involving central sensitization and neurochemical dysregulation. This review highlights the latest advancements in pharmacological and behavioral therapies for fibromyalgia.
State of knowledge
Management of fibromyalgia currently is based on a combination of medication use and non-pharmacological approaches, primarily based on physical activity and cognitive-behavioral therapy. This review explores advancements in FM treatments, focusing on novel pharmacological agents such as vortioxetine, eslicarbazepine acetate, and tapentadol, which target specific neurochemical pathways to alleviate symptoms. Vortioxetine offers new mechanisms of action with potential cognitive benefits, while eslicarbazepine acetate and tapentadol provide alternative approaches for pain modulation and central sensitization. Additionally, non-pharmacological therapies, including high-intensity interval training (HIIT) and virtual reality (VR) therapy, demonstrate promise in enhancing physical fitness, reducing pain, and improving quality of life for FM patients.
Summary
Overall, the integration of these novel therapies into comprehensive, individualized treatment plans can optimize outcomes and enhance the quality of life for individuals with FM. Ongoing research and personalized medicine approaches are essential to further refine and validate these emerging treatments.
References
Häuser, W., et al., What are the key symptoms of fibromyalgia? Results of a survey of the German Fibromyalgia Association. Der Schmerz, 2008. 22: p. 176-183.
Arnold, L.M., et al. A framework for fibromyalgia management for primary care providers. in Mayo Clinic Proceedings. 2012. Elsevier.
Wolfe, F., et al., The prevalence and characteristics of fibromyalgia in the general population. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 1995. 38(1): p. 19-28.
Buskila, D. and P. Sarzi-Puttini, Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome. Arthritis research & therapy, 2006. 8: p. 1-5.
Sluka, K.A. and D.J. Clauw, Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience, 2016. 338: p. 114-129.
Ablin, J., L. Neumann, and D. Buskila, Pathogenesis of fibromyalgia–a review. Joint Bone Spine, 2008. 75(3): p. 273-279.
Wolfe, F., et al., The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis care & research, 2010. 62(5): p. 600-610.
Roizenblatt, S., N.S.R. Neto, and S. Tufik, Sleep disorders and fibromyalgia. Current pain and headache reports, 2011. 15: p. 347-357.
Saral, I., et al., The effects of long-and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial. Rheumatology international, 2016. 36: p. 1379-1389.
Yepez, D., et al., Fibromyalgia and depression: a literature review of their shared aspects. Cureus, 2022. 14(5).
Häuser, W., et al., Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta‐analysis of randomized controlled clinical trials. Arthritis Care & Research, 2009. 61(2): p. 216-224.
Bernardy, K., et al., Cognitive behavioural therapies for fibromyalgia. Cochrane Database of Systematic Reviews, 2013(9).
Lakhan, S.E. and K.L. Schofield, Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PloS one, 2013. 8(8): p. e71834.
Langhorst, J., et al., Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatology international, 2013. 33: p. 193-207.
Häuser, W., et al., Comparative efficacy and acceptability of amitriptyline, duloxetine and milnacipran in fibromyalgia syndrome: a systematic review with meta-analysis. Rheumatology, 2011. 50(3): p. 532-543.
Lunn, M.P., R.A. Hughes, and P.J. Wiffen, Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane database of systematic reviews, 2014(1).
Nishishinya, B., et al., Amitriptyline in the treatment of fibromyalgia: a systematic review of its efficacy. Rheumatology, 2008. 47(12): p. 1741-1746.
Lawson, K., A brief review of the pharmacology of amitriptyline and clinical outcomes in treating fibromyalgia. Biomedicines, 2017. 5(2): p. 24.
Minelli, A. and A. Vaona, Effectiveness of cognitive behavioral therapy in the treatment of fibromyalgia syndrome: a meta-analytic literature review. Reumatismo, 2012. 64(3): p. 151-157.
Glombiewski, J.A., et al., Psychological treatments for fibromyalgia: a meta-analysis. PAIN®, 2010. 151(2): p. 280-295.
Farag, H.M., et al., Comparison of amitriptyline and us food and drug administration–approved treatments for fibromyalgia: a systematic review and network meta-analysis. JAMA network open, 2022. 5(5): p. e2212939-e2212939.
Vincent, A., et al., A cross-sectional assessment of the prevalence of multiple chronic conditions and medication use in a sample of community-dwelling adults with fibromyalgia in Olmsted County, Minnesota. BMJ open, 2015. 5(3): p. e006681.
Macfarlane, G.J., et al., EULAR revised recommendations for the management of fibromyalgia. Annals of the rheumatic diseases, 2017. 76(2): p. 318-328.
Chen, G., et al., Effects of intrinsic factors on the clinical pharmacokinetics of vortioxetine. Clinical Pharmacology in Drug Development, 2018. 7(8): p. 880-888.
Waller, J.A., et al., Neuroplasticity pathways and protein-interaction networks are modulated by vortioxetine in rodents. BMC neuroscience, 2017. 18: p. 1-15.
McIntyre, R.S., S. Lophaven, and C.K. Olsen, A randomized, double-blind, placebo-controlled study of vortioxetine on cognitive function in depressed adults. International Journal of Neuropsychopharmacology, 2014. 17(10): p. 1557-1567.
Sałat, K. and A. Furgała-Wojas, Serotonergic neurotransmission system modulator, vortioxetine, and dopaminergic D2/D3 receptor agonist, ropinirole, attenuate fibromyalgia-like symptoms in mice. Molecules, 2021. 26(8): p. 2398.
Sperling, M.R., et al., Eslicarbazepine acetate as adjunctive therapy in patients with uncontrolled partial‐onset seizures: results of a phase III, double‐blind, randomized, placebo‐controlled trial. Epilepsia, 2015. 56(2): p. 244-253.
Yunus, M.B. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. in Seminars in arthritis and rheumatism. 2007. Elsevier.
Mezhov, V., E. Guymer, and G. Littlejohn, Central sensitivity and fibromyalgia. Internal Medicine Journal, 2021. 51(12): p. 1990-1998.
Assenza, G., et al., The ROME (Retrospective Observational Multicenter study on Eslicarbazepine) study: efficacy and behavioural effects of Eslicarbazepine acetate as adjunctive therapy for adults with partial onset seizures in real life. Seizure, 2018. 58: p. 35-40.
Pei, W., et al., Tizanidine exerts anti-nociceptive effects in spared nerve injury model of neuropathic pain through inhibition of TLR4/NF-κB pathway. International journal of molecular medicine, 2018. 42(6): p. 3209-3219.
Patiño-Camacho, S.I., et al., Low doses of tizanidine synergize the anti-nociceptive and anti-inflammatory effects of ketorolac or naproxen while reducing of side effects. European journal of pharmacology, 2017. 805: p. 51-57.
Zayed, A., et al., Comparison between the analgesic effect of Tizanidine, Diclofenac and Gabapbentin on experimentally induced acute and chronic pain in male albino rats. Zagazig University Medical Journal, 2021. 27(5): p. 855-864.
Leiphart, J.W., et al., A comparison of intrathecally administered narcotic and nonnarcotic analgesics for experimental chronic neuropathic pain. Journal of neurosurgery, 1995. 82(4): p. 595-599.
Ghanavatian, S. and A. Derian, Tizanidine, in StatPearls [Internet]. 2022, StatPearls Publishing.
Chang, E.J., E.J. Choi, and K.H. Kim, Tapentadol: can it kill two birds with one stone without breaking windows? The Korean journal of pain, 2016. 29(3): p. 153.
Tzschentke, T., et al., Tapentadol: with two mechanisms of action in one molecule effective against nociceptive and neuropathic pain: preclinical overview. Der Schmerz, 2011. 25: p. 19-25.
Tzschentke, T.M., T. Christoph, and B.Y. Kögel, The mu-opioid receptor Agonist/Noradrenaline reuptake inhibition (MOR–NRI) concept in analgesia: the case of tapentadol. CNS drugs, 2014. 28: p. 319-329.
van de Donk, T., et al., Cornea nerve fibre state determines analgesic response to tapentadol in fibromyalgia patients without effective endogenous pain modulation. European Journal of Pain, 2019. 23(9): p. 1586-1595.
Freo, U., P. Romualdi, and H.G. Kress, Tapentadol for neuropathic pain: a review of clinical studies. Journal of pain research, 2019: p. 1537-1551.
López-Pousa, S., et al., Sense of Well‐Being in Patients with Fibromyalgia: Aerobic Exercise Program in a Mature Forest—A Pilot Study. Evidence‐Based Complementary and Alternative Medicine, 2015. 2015(1): p. 614783.
Masquelier, E. and J. D’haeyere, Physical activity in the treatment of fibromyalgia. Joint Bone Spine, 2021. 88(5): p. 105202.
Busch, A.J., et al., Exercise therapy for fibromyalgia. Current pain and headache reports, 2011. 15: p. 358-367.
Häuser, W., et al., Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis research & therapy, 2010. 12: p. 1-14.
Bodéré, C., et al., A training program for fibromyalgia management: A 5-year pilot study. SAGE Open Medicine, 2020. 8: p. 2050312120943072.
Silva, L.C., et al., Exercise Training for Women With Fibromyalgia Syndrome: A Scoping Review. Topics in Geriatric Rehabilitation, 2024. 40(2): p. 147-157.
Sosa-Reina, M.D., et al., Effectiveness of therapeutic exercise in fibromyalgia syndrome: A systematic review and meta‐analysis of randomized clinical trials. BioMed research international, 2017. 2017(1): p. 2356346.
Taylor, J.L., et al., Short-term and long-term feasibility, safety, and efficacy of high-intensity interval training in cardiac rehabilitation: the FITR heart study randomized clinical trial. JAMA cardiology, 2020. 5(12): p. 1382-1389.
Lavín-Pérez, A.M., et al., Effects of high-intensity training on the quality of life of cancer patients and survivors: a systematic review with meta-analysis. Scientific Reports, 2021. 11(1): p. 15089.
Alarcón-Gómez, J., et al., Effect of high-intensity interval training on quality of life, sleep quality, exercise motivation and enjoyment in sedentary people with type 1 diabetes mellitus. International journal of environmental research and public health, 2021. 18(23): p. 12612.
Wang, X., et al., High intensity interval training attenuates osteoarthritis-associated hyperalgesia in rats. The Journal of Physiological Sciences, 2023. 73(1): p. 8.
Polat, M., et al., The effect of virtual reality exercises on pain, functionality, cardiopulmonary capacity, and quality of life in fibromyalgia syndrome: a randomized controlled study. Games for Health Journal, 2021. 10(3): p. 165-173.
Rubio-Zarapuz, A., et al., Comparative Analysis of Psychophysiological Responses in Fibromyalgia Patients: Evaluating Neuromodulation Alone, Neuromodulation Combined with Virtual Reality, and Exercise Interventions. Medicina, 2024. 60(3): p. 404.
Shi, Y. and W. Wu, Multimodal non-invasive non-pharmacological therapies for chronic pain: Mechanisms and progress. BMC medicine, 2023. 21(1): p. 372.
Gulsen, C., et al., Effect of fully immersive virtual reality treatment combined with exercise in fibromyalgia patients: a randomized controlled trial. Assistive Technology, 2022. 34(3): p. 256-263.
Cortés-Pérez, I., et al., Virtual reality-based therapy reduces the disabling impact of fibromyalgia syndrome in women: Systematic review with meta-analysis of randomized controlled trials. Journal of personalized medicine, 2021. 11(11): p. 1167.
Knitza, J., et al., Patient's perception of digital symptom assessment technologies in rheumatology: results from a multicentre study. Frontiers in Public Health, 2022. 10: p. 844669.
Wang, H., et al., The association of mobile health applications with self-management behaviors among adults with chronic conditions in the United States. International Journal of Environmental Research and Public Health, 2021. 18(19): p. 10351.
Blanchard, M., et al., An mHealth App for Fibromyalgia-like Post–COVID-19 Syndrome: Protocol for the Analysis of User Experience and Clinical Data. JMIR Research Protocols, 2022. 11(2): p. e32193.
Lee, J., et al., Application of a real‐time pain monitoring system in Korean fibromyalgia patients: a pilot study. International journal of rheumatic diseases, 2019. 22(5): p. 934-939.
Denecke, K., N. Schmid, and S. Nüssli, Implementation of cognitive behavioral therapy in e–mental health apps: literature review. Journal of medical Internet research, 2022. 24(3): p. e27791.
Mani, M., et al., Review and evaluation of mindfulness-based iPhone apps. JMIR mHealth and uHealth, 2015. 3(3): p. e4328.
Lalloo, C., et al., Capturing daily disease experiences of adolescents with chronic pain: mHealth-mediated symptom tracking. JMIR mHealth and uHealth, 2019. 7(1): p. e11838.
Gallego, A., et al., Study protocol for a three-arm randomized controlled trial investigating the effectiveness, cost-utility, and physiological effects of a fully self-guided digital Acceptance and Commitment Therapy for Spanish patients with fibromyalgia. Digital Health, 2024. 10: p. 20552076241239177.
Hawkins, R.A., Fibromyalgia: a clinical update. Journal of Osteopathic Medicine, 2013. 113(9): p. 680-689.
Häuser, W., et al., Management of fibromyalgia: practical guides from recent evidence-based guidelines. Pol Arch Intern Med, 2017. 127(1): p. 47-56.
Guardiola‐Lemaitre, B., et al., Agomelatine: mechanism of action and pharmacological profile in relation to antidepressant properties. British Journal of Pharmacology, 2014. 171(15): p. 3604-3619.
Singh, D.R., et al., Tapentadol hydrochloride: A novel analgesic. Saudi journal of anaesthesia, 2013. 7(3): p. 322-326.
Alvarez, E., V. Perez, and F. Artigas, Pharmacology and clinical potential of vortioxetine in the treatment of major depressive disorder. Neuropsychiatric disease and treatment, 2014: p. 1297-1307.
Galiana, G.L., A.C. Gauthier, and R.H. Mattson, Eslicarbazepine acetate: a new improvement on a classic drug family for the treatment of partial-onset seizures. Drugs in R&D, 2017. 17: p. 329-339.
Atan, T. and Y. Karavelioğlu, Effectiveness of high-intensity interval training vs moderate-intensity continuous training in patients with fibromyalgia: a pilot randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 2020. 101(11): p. 1865-1876.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Oliwia Bochenek, Mateusz Koper, Aleksandra Nowak, Jessica Kałuża, Adrian Konaszczuk, Klaudia Ratyna, Oliwia Kozyra, Zofia Szypuła, Katarzyna Paluch, Małgorzata Skarbek
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 195
Number of citations: 0