Fibromyalgia

[AZ7]

Whats the use of Anticonvulsants in fibromyalgia?
Also apart from whats given in FA, any additional information or pathophys mechanism of the disease?

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[Phloston]

From UpToDate:

"In patients who do not have mild disease that responds to educational measures and exercise alone, we recommend the addition of medications (eg,amitriptyline, duloxetine, milnacipran, or pregabalin) as the next step for the treatment of the symptoms associated with fibromyalgia, rather than nonpharmacologic measures alone (Grade 1A). In general, drugs should be started at low doses and should be built up slowly. (See 'Medications'above.)

We suggest initiating therapy with a low dose of a tricyclic medication at nighttime (eg, amitriptyline) (Grade 2B). The initial amitriptyline dose is usually 10 mg one to three hours before bedtime, increased by 5 mg at two-week intervals to the minimal dose required (eg, 25 to 50 mg). The dose may be limited by adverse side effects, especially in older adults. In patients with mild to moderate symptoms, cyclobenzaprine is an alternative to amitriptyline. (See 'Medications' above and 'Tricyclic antidepressants as initial drug therapy' above and 'Cyclobenzaprine as alternative initial drug' above.)

In patients who do not respond to trials of low-dose tricyclics or who have intolerable side effects, the choice of medications is guided by patient preference, by the patient’s symptoms, and by comorbidities. (See 'Medications' above.)

In those patients who have more severe problems due to fatigue, we suggest use of a dual uptake inhibitor (Grade 2C). Examples includeduloxetine 20 to 30 mg at breakfast, gradually increased to 60 mg/day, or milnacipran 12.5 mg each morning, gradually increased as tolerated to 50 mg twice daily. (See 'Dual reuptake inhibitors/SNRI's' above and 'Duloxetine' above and 'Milnacipran' above.)

In patients with more severe problems with sleep, we suggest treatment with pregabalin taken at bedtime (Grade 2C). Treatment is initiated at a dose of 25 to 50 mg at bedtime and is adjusted upwards as tolerated to 300 to 450 mg/day. Gabapentin is an acceptable alternative for patients for whom cost or regulatory constraints limit the availability of pregabalin. (See 'Anticonvulsants (alpha2-ligands)' above and 'Pregabalin' above and'Gabapentin' above.)."