Combined use of pregabalin and memantine in fibromyalgia syndrome treatment: a novel analgesic and neuroprotective strategy?

Fibromyalgia syndrome (FMS) is a chronic widespread pain syndrome that is estimated to affect 4-8 million US adults. The exact molecular mechanisms underlying this illness remain unclear, rendering most clinical treatment and management techniques relatively ineffective. It is now known that abnormalities in both nociceptive and central pain processing systems are necessary (but perhaps not sufficient) to condition the onset and maintenance of FMS. These same systemic abnormalities are thought to be responsible for the loss of cephalic gray matter density observed in all FMS patients groups studied to date. The current scope of FMS treatment focuses largely on analgesia and does not clearly address potential neuroprotective strategies. This article proposes a combined treatment of pregabalin and memantine to decrease the pain and rate of gray matter atrophy associated with FMS. This dual-drug therapy targets the voltage-gated calcium ion channel (VGCC) and the N-methyl d-aspartate receptor (NMDAR) (respectively), two primary components of the human nociceptive and pain processing systems.

The relationship between affect balance style and clinical outcomes in fibromyalgia

OBJECTIVE

Affective balance, relative levels of negative affect (NA) and positive affect (PA), better describes emotional functioning than NA or PA alone. Affect balance styles and their relationship to clinical outcomes were compared between patients with fibromyalgia (FM) and controls.

METHODS

FM patients (n = 79) were compared with patients with other medical conditions (controls; n = 92). Patients underwent a physical examination, completed questionnaires, and were screened for clinical disorders such as depression, with diagnoses confirmed by structured interview. Affect balance style categories were calculated as follows: healthy (high PA/low NA), low (low PA/low NA), reactive (high PA/high NA), and depressive (low PA/high NA).

RESULTS

Compared with controls, FM patients had lower levels of PA (P = 0.0031; P values are adjusted for multiple testing), higher levels of NA (P = 0.0061), lower levels of functioning (P < 0.0001), and more clinical disorders (P = 0.0031). Groups differed regarding affect balance style (P = 0.0061), with FM patients being more likely than controls to be categorized as depressive (odds ratio 5.60) and reactive (odds ratio 3.81). FM patients and controls with reactive and depressive affect balance styles reported poorer functioning (P < 0.0001) compared with patients with healthy affect balance style. Finally, there was an association between affect balance style and psychiatric comorbidity (P < 0.0001), with patients with depressive and reactive affect balance styles having a 9.00 and 4.75 odds ratio, respectively, of having psychiatric comorbidity compared with patients with healthy affect balance style.

CONCLUSION

Depressive (low PA, high NA) and reactive (high PA, high NA) affect balance styles were predominant in FM patients and related to poor functioning and psychiatric comorbidity.

Pharmacological treatments of fibromyalgia: do complex conditions need complex therapies?

Fibromyalgia (FM) is a chronic pain condition, with auxiliary symptoms, such as sleep disturbances and fatigue. Although many of the mechanisms of action targeted by the drugs used to treat FM have been focused to the management of single symptoms, drugs (e.g. pregabalin, duloxetine) have now been identified that demonstrate a multidimensional effect. However, such drugs often fail to demonstrate acceptable efficacy in the majority of the patient population. Thus, the mechanisms of action of the drugs studied as treatments for FM are either identifying subgroups within the pathophysiology of the condition or suggesting that a mechanism of action that will offer universal efficacy has, as yet, to be identified.