Malik Aila, Brown Zoe, Ryder Alexa, Balayan Vanshika, Jameson Lauren, Vu Peter, Al-Jumah Rana, Hasoon Jamal
Malik, University of Texas Health Science Center at Houston, Department of Physical Medicine and Rehabilitation, Houston, TX, USA.
Brown, University of Texas Health Science Center at Houston, Department of Anesthesiology, Critical Care, and Pain Medicine, Houston, TX, USA.
Psychopharmacol Bull. 2025 Feb 3;55(2):24-40.
Fibromyalgia is a complex clinical entity characterized by a broad range of symptoms including chronic widespread musculoskeletal pain, profound fatigue, impaired cognition, and mood disturbances. Current understanding of disease pathogenesis assumes neurotransmitter dysregulation and central pain sensitization play a key role resulting in heightened pain sensitivity. Genetic predisposition as well as alterations in endocrine and immune function have been implicated. Accurate diagnosis requires a comprehensive evaluation, and a personalized treatment approach is needed to address the biopsychosocial components of the disease process. Among pharmacologic treatment options, serotonin norepinephrine reuptake inhibitors (SNRIs) have demonstrated analgesic effects in addition to mood stabilizing properties. Currently, duloxetine and milnacipran are approved by the Food and Drug Administration although other agents in this drug class including venlafaxine and desvenlafaxine have been studied in the management of fibromyalgia. In addition, selective norepinephrine reuptake inhibitors, esreboxetine and reboxetine, as well as tramadol, a weak opioid mu-receptor agonist with SNRI activity have shown potential utility. Although some studies have demonstrated SNRIs to be effective and well tolerated in patients with fibromyalgia, individual response may vary. There remains a continued need for large scale clinical trials to establish the safety and clinical effectiveness of these agents in this patient population. Further information is needed to optimize patient selection and dosing regimens as well as elucidate the clinical factors associated with poor response. Moreover, pharmacologic agents may be combined with lifestyle changes and non-drug-based treatments to address the complex interactions of biological and psychosocial factors that facilitate disease development and persistence of symptoms.
纤维肌痛是一种复杂的临床病症，其特征为广泛的症状，包括慢性广泛性肌肉骨骼疼痛、极度疲劳、认知障碍和情绪紊乱。目前对该疾病发病机制的理解认为，神经递质失调和中枢性疼痛敏化起着关键作用，导致疼痛敏感性增强。遗传易感性以及内分泌和免疫功能的改变也与此有关。准确的诊断需要全面评估，并且需要个性化的治疗方法来解决疾病过程中的生物心理社会因素。在药物治疗选择中，5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）除了具有稳定情绪的特性外，还显示出镇痛作用。目前，度洛西汀和米那普明已获美国食品药品监督管理局批准，尽管该药物类别中的其他药物，包括文拉法辛和去甲文拉法辛，已在纤维肌痛的治疗中进行了研究。此外，选择性去甲肾上腺素再摄取抑制剂、艾司西酞普兰和瑞波西汀，以及曲马多（一种具有SNRI活性的弱阿片μ受体激动剂）也显示出潜在的效用。尽管一些研究表明SNRIs对纤维肌痛患者有效且耐受性良好，但个体反应可能会有所不同。仍然需要大规模的临床试验来确定这些药物在该患者群体中的安全性和临床有效性。需要更多信息来优化患者选择和给药方案，并阐明与不良反应相关的临床因素。此外，药物治疗可与生活方式改变和非药物治疗相结合，以解决促进疾病发展和症状持续存在的生物和心理社会因素的复杂相互作用。
