Browsing articles tagged with "Fibromialgia Archives - Updates en Rehabilitación"

Inhibidores de la recaptación de serotonina y noradrenalina en Fibromialgia: Actualizacion Cochrane

Inhibidores recaptacion noradrenalina y serotoninaSe ha publicado una revisión Cochrane sobre el papel de los Inhibidores de la recaptación de serotonina y noradrenalina en la Fibromialgia.
Ya hemos hablado en otras ocasiones de distintos tratamientos farmacológicos en la Fibromialgia, con distintos resultados.
En ésta ocasión se observó una reducción del dolor con el tratamiento vs placebo, aunque no se observaron cambios substanciales en parámetros de fatiga, calidad de vida o en la calidad del sueño.
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Fibromyalgia syndrome (FMS) is a clinically well-defined chronic condition of unknown etiology characterized by chronic widespread pain that often co-exists with sleep disturbances, cognitive dysfunction and fatigue. Patients often report high disability levels and poor quality of life (QOL). Drug therapy focuses on reducing key symptoms and improving quality of life.


To assess the benefits and harms of serotonin and noradrenaline reuptake inhibitors (SNRIs) compared with placebo for treating FMS symptoms in adults.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library 2012, Issue 9), MEDLINE (1966 to September 2012), EMBASE (1980 to September 2012), (U.S.-marketed pharmaceuticals) (to September 2012) and (to September 2012) for published and ongoing trials and examined the reference lists of reviewed articles.

Selection criteria

We selected randomized, controlled trials of any formulation of SNRIs against placebo for the treatment of FMS in adults.

Data collection and analysis

Two review authors independently extracted the data from the included studies, and assessed the risks of bias of the studies. Discrepancies were resolved by discussion.

Main results

Ten studies were included with a total of 6038 participants. Five studies investigated duloxetine against placebo, and five investigated milnacipran against placebo. A total of 3611 participants were included into duloxetine or milnacipran groups and 2427 participants into placebo groups. The studies had a low risk of bias in general. Duloxetine and milnacipran had a small incremental effect over placebo in reducing pain (standardized mean difference (SMD) -0.23; 95% confidence interval (CI) -0.29 to -0.18; 6.1% relative improvement). One-hundred and ninety-two participants per 1000 on placebo reported an at least 50% pain reduction compared to 280 per 1000 on SNRIs (Risk ratio (RR) 1.49, 95% CI 1.35 to 1.64; number needed to treat to benefit (NNTB) 11, 95% CI 9 to 15). Duloxetine and milnacipran did not reduce fatigue substantially (SMD -0.14; 95% CI -0.19 to -0.08; 2.5% relative improvement; NNTB 17, 95% CI 12 to 29), and did not improve QOL substantially (SMD -0.20; 95% CI -0.25 to -0.14; 4.6% relative improvement; NNTB 12, 95% CI 9 to 17) compared to placebo. There were no statistically significant differences between either duloxetine or milnacipran and placebo in reducing sleep problems (SMD -0.07; 95% CI -0.16 to 0.03; 2.5% relative improvement). One-hundred and seven participants per 1000 on placebo dropped out due to adverse events compared to 196 per 1000 on SNRIs. The dropout rate due to adverse events in the duloxetine and milnacipran groups was statistically significantly higher than in placebo groups (RR 1.83, 95% CI 1.53 to 2.18; number needed to treat to harm (NNTH) 11, 95% CI 9 to 13). There was no statistically significant difference in serious adverse events between either duloxetine or milnacipran and placebo (RR 0.78, 95% CI 0.55 to 1.12).

Authors’ conclusions

The SNRIs duloxetine and milnacipran provided a small incremental benefit over placebo in reducing pain. The superiority of duloxetine and milnacipran over placebo in reducing fatigue and limitations of QOL was not substantial. Duloxetine and milnacipran were not superior to placebo in reducing sleep problems. The dropout rates due to adverse events were higher for duloxetine and milnacipran than for placebo. The most frequently reported symptoms leading to stopping medication were nausea, dry mouth, constipation, headache, somnolence/dizziness and insomnia. Rare complications of both drugs may include suicidality, liver damage, abnormal bleeding, elevated blood pressure and urinary hesitation.



Häuser W, Urrútia G, Tort S, Üçeyler N, Walitt B.

Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome.

Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD010292. DOI: 10.1002/14651858.CD010292.


Ácido valproico y valproato de sodio en dolor neuropático y fibromialgia. Revisión Cochrane

Ácido Valproico

Cochrane Database Syst Rev. 2011 Oct 5;(10):CD009183.
Valproic acid and sodium valproate for neuropathic pain and fibromyalgia in adults.
Gill D, Derry S, Wiffen PJ, Moore RA.

BACKGROUND: Valproic acid and its sodium salt (sodium valproate) are antiepileptic drugs that are sometimes used to treat chronic neuropathic pain and fibromyalgia, although they are not licensed for this use.

OBJECTIVES: To evaluate the analgesic efficacy and adverse effects of valproic acid and sodium valproate in the management of chronic neuropathic pain and fibromyalgia.

SEARCH STRATEGY: We identified randomised controlled trials (RCTs) of valproic acid and sodium valproate in acute, and chronic pain by searching MEDLINE, EMBASE and Cochrane CENTRAL to June 2011, together with reference lists of retrieved papers and reviews.

SELECTION CRITERIA: RCTs that were double blind and of eight-weeks duration or longer, reporting on analgesic effects and adverse events with valproic acid and sodium valproate in the treatment of chronic neuropathic pain and fibromyalgia.

DATA COLLECTION AND ANALYSIS: Two review authors independently extracted results and scored for quality. We extracted efficacy and adverse event data, and examined issues of study quality.
MAIN RESULTS: We included three studies, two in diabetic neuropathy (42 participants treated with valproate, 42 with placebo), and one in post-herpetic neuralgia (23 treated with divalproex sodium, 22 with placebo). Study duration was eight or 12 weeks. No studies were found in fibromyalgia.Only one study reported one of our primary outcomes (>/= 50% pain relief), while all three reported group means for pain reduction from baseline to endpoint. In all three studies; efficacy results were given only for participants who completed the study. One study in diabetic neuropathy and the study in post-herpetic neuralgia reported significant differences between active and placebo groups, but there were insufficient data for reliable pooled analysis.More adverse events were reported with active treatment than placebo, and included nausea, drowsiness and abnormal liver function tests. One participant taking sodium valproate withdrew due to serious derangement of liver enzymes.

AUTHORS’ CONCLUSIONS: These three studies no more than hint that sodium valproate may reduce pain in diabetic neuropathy, and divalproex sodium in post-herpetic neuralgia, but the use of `completer` analysis may overestimate efficacy, and there were too few data for pooled analysis of efficacy or harm, or to have confidence in the results of the individual studies. There is insufficient evidence to support the use of valproic acid or sodium valproate as a first-line treatment for neuropathic pain. There is more robust evidence of greater efficacy for a small number of other drugs.

Texto completo: Ácido valproico y valproato de sodio en dolor neuropático y fibromialgia. Revisión Cochrane


Terapia hormonal sustitutiva en Fibromialgia postmenopáusica

Ya hemos visto varias intervenciones terapéuticas en la Fibromialgia. Os dejo un nuevo artículo sobre el uso de Terapia hormonal sustitutiva.
El déficit de estrógenos se ha postulado como un posible factor predisponente/relacionado con la fibromialgia ya que parecen intervenir en la modulación y percepción del dolor.

Rheumatology (Oxford). 2011 Mar;50(3):544-51. Epub 2010 Nov 14.
Hormonal replacement therapy does not affect self-estimated pain or experimental pain responses in post-menopausal women suffering from fibromyalgia: a double-blind, randomized, placebo-controlled trial


  • Tipo: Ensayo aleatorizado, controlado con placebo.
  • Conclusiones: Ocho semanas de tratamiento transdérmico de estradiol no influye en la percepción del dolor, los umbrales de dolor o la tolerancia al dolor, en comparación con el tratamiento con placebo en mujeres posmenopáusicas que sufren de FM.

Podemos leer el abstract: Terapia hormonal sustitutiva en Fibromialgia postmenopáusica


Gabapentina para el dolor neuropático crónico y la fibromialgia: Revisión Cochrane

Se ha publicado una actualización de una revisión Cochrane sobre el uso gabapentina en dolor neuropático crónico. El antecedente de la Cochrane es una revisión del 2005, actualizada en enero de 2010 y que concluía: No hay evidencia de que los anticonvulsivantes sean efectivos para el dolor agudo. En los síndromes de dolor crónico que no sea la neuralgia del trigémino, el uso de anticonvulsivantes debe aplazarse hasta que otras intervenciones hayan sido revisadas. Aunque la gabapentina es cada vez más utilizada para el dolor neuropático, las pruebas sugieren que no es superior a la carbamazepina.

Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001133.
WITHDRAWN. Anticonvulsant drugs for acute and chronic pain.
Wiffen PJ, Collins S, McQuay HJ, Carroll D, Jadad A, Moore RA.

Es un ejemplo de conclusión de la Cochrane que se aleja de la práctica clínica diaria. Actualmente el uso de gabapentina (o antiepilépticos más recientes como pregabalina) y otros adyuvantes para el dolor está generalizado, no sólo en Rehabilitación sino también en otras especialidades y Atención Primaria.

Cochrane Database Syst Rev. 2011 Mar 16;3:CD007938.
Gabapentin for chronic neuropathic pain and fibromyalgia in adults.
Moore RA, Wiffen PJ, Derry S, McQuay HJ.


  • Tipo: Revisión Cochrane.
  • Conclusiones: La gabapentina alivia el dolor en cerca de un tercio de las personas con dolor neuropático. Los efectos adversos son frecuentes, pero en su mayoría son tolerables. Las estimaciones más conservadoras son resultado del uso de definiciones de resultados de eficacia en niveles clínicamente más altos, en combinación con un aumento en el número de estudios y participantes para el análisis.

Podemos leer el abstract: Gabapentina para el dolor neuropático crónico y la fibromialgia.