针对纤维肌痛的药物
卡伦·李·理查兹（Karen Lee Richards）
Prescribed medications are a key component of mostfibromyalgia treatment计划。由于目前只有三种FDA批准的药物fibromyalgia，许多药物被开处方。这意味着该药物是针对其批准的其他用途的规定。由于已经发表了许多研究表明，各种药物可能对纤维肌痛患者有益，因此医生可以在标签外开处方这些药物。
请记住，没有任何一种药物适用于每位纤维肌痛患者。同样，FM患者通常比普通人对药物更敏感，因此在开处方纤维肌痛的药物时应采取良好的护理和考虑。有时有必要从较低剂量开始以防止不良反应。由于这通常是反复试验的问题，因此对于患者和医生来说，找到最好的治疗计划很重要。
以下是最常用于治疗纤维肌痛的七类药物：
1.镇痛药
镇痛药是止痛药。它们包括：
Over-the-counter medications like aspirin, acetaminophen, ibuprofen and naproxyn. (Ibuprofen and naproxyn are also anti-inflammatories)
非甾体类抗炎（NSAIDS），例如依托多拉克，nabumetone和Cox-II抑制剂（例如，Celebrex).
Corticosteroid anti-inflammatories like prednisone and dexamethasone.
Tramadol，一种麻醉性的鸦片激动剂。
自从fibromyalgiais not a true inflammation, anti-inflammatories may be less effective in reducing pain. They can, however, be helpful in reducing pain flares brought on by strenuous physical activity, tendonitis or bursitis. Because many of the NSAIDs carry a serious risk of gastrointestinal bleeding and some also have a cardiovascular risk, they should be taken with great caution and care.
Recent studies have indicated thatopiate pain medications often do not relieve FM pain。看来纤维肌痛患者中的MU-Apoid受体具有降低与靶向药物的药物结合的能力。还有一些新的证据表明，从长远来看，使用高剂量阿片类药物实际上可能会增加FM患者对疼痛的过敏性。
Tramadol is a synthetic opioid. Although it is described as "opiate-like" and is considered an opiate agonist, it differs from other opioids in the way it acts on the central nervous system. Unlike other opioids, it is not considered a controlled substance in the U.S. and many other countries. Thus far studies on the effectiveness of tramadol in relieving FM pain have had quite positive results.
2.抗抑郁药
Antidepressants are often among the first treatment options tried for fibromyalgia patients because they can improve sleep, reduce pain and help mood disturbances. There are three categories of antidepressants:
Tricyclics like amitriptyline, nortriptyline and trazodone can be effective and were the favored FM treatment for many years. However, because of frequent side effects such as dry mouth and the "morning hangover" effect, newer types of antidepressants may be preferable.
选择性5-羟色胺再摄取抑制剂（SSRIS）Lexapro,paxil.，Zoloft，百忧解和Celexa increase the serotonin concentration in the body (which is low in FM patients) by blocking the breakdown of serotonin. Because SSRIs can be particularly effective in treating depression, they may be a good choice for fibromyalgia patients who also suffer from depression. On the downside, SSRIs can cause sexual dysfunction and weight gain.
5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIS），例如c c省，EffExor和Savellaare the newest and perhaps most promising class of antidepressants to be used in the treatment of fibromyalgia. They increase both serotonin and norepinephrine concentrations in the body by blocking their breakdown. Cymbalta received FDA approval for the treatment of fibromyalgia in June 2008. Studies have found that it can reduce pain, improve energy, decrease anxiety, improve depression, and help alertness and concentration with only minimal side effects. It has also been found to be beneficial for FM patients who are not clinically depressed. Savella was approved by the FDA to treat FM in January 2009 and is expected to be in pharmacies by mid-2009. Clinical trials showed that many of the patients taking Savella reported improvements in pain, physical function, and patient global assessment. Remeron is another SNRI that is being used by pain specialists for its ability to promote sleep and it's suspected ability to reduce pain and headache symptoms.
3. Anti-convulsants
Two anti-convulsant or anti-seizure medications that have been used to treat fibromyalgia areLyrica和Neurontin。Lyricahas the distinction of being the first medication ever to receive FDA approval for the treatment of fibromyalgia. It works by affecting chemicals in the brain that send pain signals across the nervous system. In clinical trials, Lyrica reduced pain and improved sleep, fatigue and general health perception in 30 to 40 percent of FM patients. The most common side effects were dizziness and sleepiness.
Neurontinhas been found to help neuropathic pain. Fibromyalgia patients who have burning or pain that feels like electric shocks in their hands and feet have reported improvement when treated with Neurontin.
4.肌肉放松剂
肌肉松弛剂喜欢弹性,Soma,skelaxin和robaxin有时会针对纤维肌痛疼痛开处方。尽管它们实际上可能没有停止肌肉痉挛，但它们似乎具有减轻肌肉疼痛的中心神经系统机制。最常见的副作用是嗜睡。如果肌肉痉挛是一个特殊的问题，那么诸如Zanaflex和Baclofen之类的杂质药物可能有助于减轻痉挛和疼痛。由于Zanaflex似乎可以有效地改善睡眠，阻塞疼痛和减轻头痛，因此即使肌肉痉挛不是主要问题，有时也会开处方。
5. Anti-anxiety Medications
纤维肌痛患者的焦虑会增加疼痛，肌肉张力，烦躁和睡眠问题。如果焦虑是一个问题，那么苯二氮卓类药物等药物，例如克洛诺蛋白，ativan和Xanax可以帮助减轻疼痛并改善睡眠。它们通过改善中枢神经系统中抑制性和兴奋性受体的平衡来起作用。（大多数FM患者的兴奋性受体活动过多。）晚上服用的克洛诺蛋白对患有很多腿部问题的患者特别有用，包括疼痛，躁动不安或抽搐的腿。
6.睡眠修饰符
对于大多数纤维肌痛的人来说，无法深入，令人耳目一新的睡眠是一个主要问题。尽管已经讨论过的许多药物可以帮助改善睡眠，但有时需要专门诱导睡眠的药物。有两种类型的睡眠修饰符：
Benzodiazepines like Restoril can be used to treat insomnia. The biggest concern about using benzodiazepines is their habit-forming potential.
催眠药，例如Ambien, Lunesta and Rozerem cause relaxation that helps patients fall asleep and stay asleep. Ambien is less habit forming than the benzodiazepines but can cause rebound insomnia when it is stopped. The newer hypnotics Lunesta and Rozerem are not habit-forming and do not produce rebound insomnia.
7.其他
最初为治疗发作性发育症而开发的神经系统药物有时也用于治疗纤维肌痛的疲劳。在2006年的一项研究中，服用普罗维吉尔的纤维肌痛患者中有三分之二的疲劳水平降低了50％。
Sources:
Pellegrino，M（2005）。纤维肌痛：接近和个人。Anadem Publishing。
Ervin, J.E., Dyer, D., Fox, C. (2007, Sept. - Nov.). Medication Update. Fibromyalgia AWARE, 14, 60-61.
©Karen Lee Richards
Last updated 1/26/09
