Fibromyalgia is usually treated by a combination of nonpharmacological and pharmacological elements. Due to the fact that fibromyalgia causes chronic pain, pharmacological therapy plays the major role in treating patients with diagnosed fibromyalgia. Objectively, fibromyalgia makes it impossible to completely eliminate pain, but relieving the burden of pain is necessary to improve the health state and wellbeing of patients, and to improve the overall quality of disease management in different population groups. To begin with, treatment strategies of fibromyalgia imply the need to use three distinct classes of drugs: non-narcotic analgesics, narcotic analgesics, and adjuvant medications (Ostalecki, 2007). Adjuvant medications usually comprise a whole group of anticonvulsants and antidepressants that work to enhance the effectiveness of analgesics (Arnold, Keck & Weldge, 2000). Among non-narcotic analgesics, acetaminophen remains the basic element of fibromyalgia treatment: it is the safest analgesic that reduces fever and mild pain; “if taken at recommended doses, acetaminophen has no known stomach, kidney, or cardiovascular side effects” (Goldenberg, Burckhardt & Crofford, 2004).Unfortunately, medical professionals and researchers lack specific knowledge about acetaminophen pharmacokinetics. It is suggested that this analgesic does not impact synthesis of prostaglandin, and should be further combined with stronger analgesics similar to tramadol (Ostalecki, 2007). Tramadol is a well-known medical preparation that alters brain perceptions of pain and does not produce any adverse effects on kidneys, cardiovascular system, or liver. Tramadol targets central nervous system in general, and its opioid receptors in particular; it does not produce any effect on prostaglandins and does not affect any inflammatory symptoms (Ostalecki, 2007). It is recommended that tramadol and acetaminophen are also balanced with nonsteroid anti-inflammatory drugs (NSAIDs), including aspirin. Generally, NSAIDs inhibit cyclooxygenase (COX); given that the two different types of COX have been identified in human organism, NSAIDs are designed to target only COX-2 which is usually present in inflamed tissues and is responsible for pain regulation (Sorensen, Bengtsson & Backman, 1995).
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Certainly, pharmacological treatment of fibromyalgia is impossible without narcotic analgesics. Objectively, and researchers keep to this opinion, “there is controversy about the use of opiates to manage the pain associated with fibromyalgia because of the abuse potential of these agents and the lack of data supporting their efficacy in fibromyalgia” (Sorensen, Berngtsson & Backman, 1995). That is why to reduce the probability of adverse effects narcotic analgesics are prescribed only if (a) all previous medical therapies did not produce any significant pain relief and if (b) pain substantially impacts the quality of patients’ life (Ostalecki, 2007). It should be noted, that the results of recent researches confirm the changes which nociceptive system in CNS undergoes under the impact of continuous pain in fibromyalgia patients. Thus, such pain can be fairly regarded as a separate disease and requires a well developed pharmacological treatment that may also involve narcotic analgesics (Bennett & Russell, 2002). Pharmacokinetics of all narcotic analgesics is based on the mechanism that blocks noxious stimuli transmission to the brain. Unfortunately, the use of narcotics is associated with a whole range of adverse effects, including euphoria, confusion, drowsing, and even constipation. The combination of tramadol and acetaminophen can be the major cause of dizziness, somnolence, and nausea (Goldenberg, Burckhardt & Crofford, 2004). Nevertheless, for many patients the use of narcotic drugs is the only chance to relieve pain. The third and the final component of pharmacological treatment in fibromyalgia is the so-called adjuvant medication. In other words, these are antidepressants and serotonin reuptake inhibitors that can enhance the effectiveness of non-narcotic and narcotic analgesics. Both tricyclic antidepressants and selective serotonin uptake inhibitors inhibit the reuptake of serotonin or norepinephrine, which are responsible for the transmission of electrical pain currents in human brain (Arnold et al, 2004). Duloxetine is one out of the few modern medications used to reduce physical symptoms of pain in patients with diagnosed fibromyalgia.
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