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).
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. Evidence-based studies confirm that “duloxetine 60 mg QD and 60 mg BID for up to 12 weeks are safe and effective in the treatment of fibromyalgia” (Arnold et al, 2004). Milnacipran is just another serotonin reuptake inhibitor used to reduce the display of pain symptoms in fibromyalgia patients (Ostalecki, 2007). It should be noted, however, that these adjuvant medications work more effectively for non-depressed than depressed patients; thus, before prescribing these medications, a whole range of depression and psychology assessments need to be performed, to exclude the symptoms of depression or other mood disorders in fibromyalgia patients.