Sunday, April 10, 2011


Note: Unlike anti-depressants, Lyrica (pregabalin) specifically
targets neuropathic pain and is vetted by the FDA for such. One reason
that subgroups of fibromyalgia patients may not all respond to
anti-depressants is because the diagnostic criteria has been diluted
or like CFS, fibromyalgia is an umbrella term that includes multiple
diseases or diseases that have core symptoms in common.

Open Rheumatol J. 2010 Oct 11;4:35-38.
Pregabalin in Treatment-Refractory Fibromyalgia.
Stacey BR, Emir B, Petersel D, Murphy K.

Comprehensive Pain Center, Department of Anesthesiology and
Peri-Operative Medicine, Oregon Health & Science University, Portland,
CONTEXT: Fibromyalgia is a chronic musculoskeletal pain disorder. The
pain can be intractable and may not respond to commonly-used
treatments, such as tricyclic antidepressants and opioids.

OBJECTIVES: To evaluate pregabalin response in the subset of patients
with fibromyalgia whose pain had been judged refractory to other

METHODS: Patients had previously participated in a controlled trial of
pregabalin and had moderate to severe pain despite treatment with
gabapentin, a tricyclic antidepressant, and a third medication (e.g.,
other anticonvulsants, opioid, selective serotonin reuptake
inhibitors, tramadol). Flexible-dose pregabalin 150-600 mg/day was
added for 3-month treatment cycles, each followed by 3- to 28-day
pregabalin "drug holiday" that lasted until a relapse occurred. Pain
intensity was measured using the visual analogue scale of the
Short-Form McGill Pain Questionnaire completed at baseline, the end of
each 3-month treatment period and at the relapse visit. Analysis was
at 15 months (after 5 cycles).

RESULTS: In total, 25 patients were included and 19 completed the
15-month analysis period. At baseline, 88% were receiving ≥1 pain
medication. Pregabalin 150-600 mg/day was associated with
statistically significant, clinically meaningful pain reduction during
each treatment cycle. Pain quickly returned to baseline levels during
the "drug holidays" in a median time of 2-4 days. Somnolence (n=5) and
dizziness (n=4) were the most common adverse events.

CONCLUSIONS: These results suggest that pregabalin may be beneficial
in patients with fibromyalgia who have had an unsatisfactory response
to treatment with other medications.

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