Diet and Lifestyle Modifications for Fibromyalgia
9
Citation
93
Reference
10
Related Paper
Citation Trend
Abstract:
Abstract: Fibromyalgia (FM) is a complex, widespread pain disorder characterized by symptoms such as fatigue, sleep deprivation, mental fog, mood swings, and headaches. Currently, there are only three FDA-approved medications for FM patients: duloxetine, milnacipran, and pregabalin, with outcomes frequently being inadequate. This research team aims to investigate the effects of diet and lifestyle modifications on FM, with emphasis on anti-inflammatory diet, antioxidants, and gluten-free diets, as well as supplementation with Magnesium, CQ10, and Vitamin D, microbiome, sleep, exercise, and cognitive behavioral therapy. We reviewed the pathophysiology of certain foods that can be proinflammatory with the release of cytokines leading to activation of pain, fatigue and aggravation of the majority of Fibromyalgia symptoms. A literature review was performed by identifying FM articles published between 1994 and 2022 via PubMed and EMBASE databases, with particular emphasis on randomized controlled trials, meta-analysis, and evidence-based treatment guidelines. This review article was completed by a comprehensive narrative review process, in which our team systematically examined relevant scientific literature to provide a comprehensive overview of the significant role that diet and other lifestyle modifications play in mediating symptoms of Fibromyalgia. We propose that diet modifications and lifestyle changes, such as sleep, exercise, and weight loss, can be important steps in managing FM.Keywords:
Pregabalin
Milnacipran
Pregabalin
Milnacipran
Duloxetine Hydrochloride
Cite
Citations (62)
Fibromyalgia is a chronic condition characterized by widespread pain, fatigue, and sleep disturbances that affects approximately 2% to 4% of the adult population in the United States, with minimal real-world data related to the use of medications and associated dosages for this condition.To analyze the real-world dosing patterns of the 3 medications approved by the US Food and Drug Administration for fibromyalgia-pregabalin, duloxetine, and milnacipran.Using QuintilesIMS' (now IQVIA) electronic medical record data linked to administrative claims, we identified adults with fibromyalgia who were newly prescribed pregabalin, duloxetine, or milnacipran between January 1, 2006, and December 31, 2014. We summarized and compared the starting and maximum doses with United States prescribing information (USPI) dosing recommendations.In all, 1043 patients who were receiving pregabalin, 1281 receiving duloxetine, and 326 patients receiving milnacipran with similar age and comorbidity profiles were included in the study. The mean starting dose was 176 mg daily, 56 mg daily, and 95 mg daily for pregabalin, duloxetine, and milnacipran, respectively. More patients receiving pregabalin (35%) had a starting dose lower than recommended compared with patients receiving duloxetine (7%) or milnacipran (17%; P <.0001). Of the patients who received pregabalin, 27% had USPI-recommended maintenance dosing versus 91% of patients who received duloxetine and 80% who received milnacipran (P <.0001). The mean duration of treatment was longer for duloxetine (205 days; P <.0001) than for pregabalin (167 days) and milnacipran (167 days). The duration of using the maximum dose of each medication as a percentage of the total time of medication use was 77% for pregabalin, 84% for duloxetine, and 90% for milnacipran (P <.0001).Patients using pregabalin were the most likely of the 3 cohorts to receive lower than label-recommended starting doses and the least likely to receive the recommended maintenance doses during follow-up compared with those receiving duloxetine or milnacipran. Real-world prescribing patterns indicate that factors other than label recommendations may be influencing prescribed dosing.
Milnacipran
Pregabalin
Cite
Citations (13)
Pregabalin
Milnacipran
Duloxetine Hydrochloride
Cite
Citations (0)
Abstract Background: The economic burden associated with fibromyalgia in the U.S. is substantial. The objective of this study was to compare changes in health care costs in fibromyalgia patients initiated on pregabalin and duloxetine in real‐world settings. Methods: Patients (≥ 18 years old) initiating pregabalin or duloxetine between June 1, 2007 and December 31, 2008 were identified using a U.S. managed care database. Patients were selected if they had ≥ 2 medical claims for fibromyalgia (ICD‐9‐CM, 729.1) at least 90 days apart or ≥ 1 claim for fibromyalgia followed within 30 days by a pharmacy claim for pregabalin. The date of the first pregabalin or duloxetine prescription was defined as the index date, and continuous enrollment for 6‐month pre‐ and postindex periods was required. Results: A total of 1,616 pregabalin and 207 duloxetine patients were identified. Treatment differences between pregabalin and duloxetine in the pre‐/postindex change in mean [SD] all‐cause total health care costs ($1,307 [16,747] vs. −$158 [17,337]; P = 0.24) or fibromyalgia‐related total health care costs ($584 [3,834] vs. $759 [2,133]; P = 0.32) were not significant. Multivariate analysis using difference‐in‐differences models showed no significant difference in all‐cause costs (mean cost ratio = 1.05, 95% CI: 0.84 to 1.31) or fibromyalgia‐related costs (0.85, 95% CI: 0.61 to 1.18) between treatments during the postindex period. Conclusion: No significant differences were found between pregabalin and duloxetine in the pre‐ to postindex change in mean all‐cause or fibromyalgia‐related total health care costs.
Pregabalin
Cite
Citations (15)
Pregabalin
Cite
Citations (0)
Fibromyalgia is a disorder characterized by chronic widespread musculoskeletal pain and stiffness. In 2007, the US FDA approved pregabalin as the first drug indicated for the management of fibromyalgia. Within 18 months, the agency had also approved duloxetine and milnacipran for the same indication. However, although these drugs are already marketed in Europe for other indications, the European regulatory authorities recently rejected extending approval for these three drugs for the treatment of fibromyalgia. This editorial discusses the possible reasons for this 'transatlantic difference'.
Milnacipran
Pregabalin
Fibromyalgia syndrome
Cite
Citations (27)
Pregabalin
Milnacipran
Cite
Citations (0)
A clinical decision report using: Gilron I, Chaparro LE, Tu D, et al. Combination of pregabalin with duloxetine for fibromyalgia. Pain. 2016;157(7):1532–1540. https://doi.org/10.1097/j.pain.0000000000000558 for a patient with chronic pain due to fibromyalgia.
Pregabalin
Cite
Citations (0)
Abstract Objective To examine the efficacy of duloxetine vs. pregabalin in the treatment for diabetic peripheral neuropathic pain ( DPNP ), comparing patient subgroups with and without concomitant antidepressant use. Methods This post hoc analysis assessed data from a randomized 12‐week study that confirmed the noninferiority of duloxetine to pregabalin. In the previously published study, patients with DPNP with inadequate response to gabapentin were switched to duloxetine monotherapy, combination therapy of duloxetine plus gabapentin, or pregabalin monotherapy. Current, stable antidepressant use was allowed; 79 patients were concomitantly treated with antidepressants and 328 without antidepressants. In this post hoc analysis, improvement in the weekly mean of diary‐based average daily pain ratings (numerical rating scale: 0–10) in antidepressant users and nonusers was analyzed using a longitudinal mixed‐models repeated‐measures ( MMRM ) analysis, including a test of the 3‐way interaction (antidepressant subgroup by treatment by week) to assess whether the differences among treatment groups over 12 weeks differ between the antidepressant‐use subgroups. Results The 3‐way interaction was significant ( P = 0.035), demonstrating that treatment‐group differences in pain reduction over time differ between the subgroups. Among patients without antidepressant use, patients treated with duloxetine had significantly greater pain reduction than pregabalin at Week 4 and at each successive week up to the 12‐week endpoint (−2.8 for duloxetine and −2.1 for pregabalin; P = 0.031); patients treated with duloxetine plus gabapentin had greater pain reduction than pregabalin at Weeks 2, 3, 5, and 7 to 9 ( P ≤ 0.05) but not at endpoint (−2.4; P = 0.222). Among concomitant antidepressant users, no treatment‐group differences were found. Conclusions In patients with DPNP inadequately treated with gabapentin without the concomitant use of antidepressants, switching to duloxetine instead of pregabalin may provide better pain reduction. Conversely, in nonresponders to gabapentin who are concomitantly using an antidepressant, switching to duloxetine or pregabalin may provide similar pain reductions.
Pregabalin
Post-hoc analysis
Duloxetine Hydrochloride
Cite
Citations (34)
Introduction: Our trial (ClinicalTrials.gov Identifier: NCT04246619) evaluates the efficacy of two generic medications, pregabalin and duloxetine, for treating pain in PDPN patients. Methods: The patients were randomised either into the pregabalin (99) or the duloxetine (102) arm. Pain was evaluated using the DN-4 questionnaire, and visual analogue scales (VASs, 0–100 mm) were used to measure the average pain intensity (API), worst pain intensity (WPI) in the last 24 h and current pain intensity (CPI). Results: The proportion of patients with a clinically significant improvement in the API at Week 12 was 88.3% [CI 81.7%, 94.8%] in the pregabalin arm and 86.9% [CI 76.7%, 97.1%] in the duloxetine arm. After 12 weeks, the CPI, API, and WPI decreased by −35.3 [−40.5, −30.0], −37.0 [−41.4, −32.6], and −41.6 [−46.6, −36.5] in the pregabalin arm, and by −35.0 [−39.2, −30.7], −36.9 [−41.5, −32.3], and −40.0 [−44.8, −35.2] in the duloxetine arm (all in mm, all p < 0.001). Conclusion: Our results demonstrate that pregabalin and duloxetine are effective medications for treating pain in PDPN in more than 86% of all randomised patients.
Pregabalin
Duloxetine Hydrochloride
Cite
Citations (3)