| The treatment of fibromyalgia syndrome appears to | | | | dopaminergic agent, pramipexole, with intriguing |
| be entering something of a golden age. Recently, | | | | results. Compared with the control group, patients in |
| after years of struggling just to be taken seriously, | | | | this study experienced gradual, significant |
| fibromyalgia patients have witnessed the release of a | | | | improvement in measurements of pain, fatigue, |
| series of medications indicated for the treatment of | | | | function, and overall well-being, suggesting that |
| fibromyalgia syndrome. While it is true that these | | | | dopaminergic agents may be of value in the |
| medications are far from perfect and aren't effective | | | | treatment of fibromyalgia syndrome.(4) |
| for everyone, they have provided a strong sense of | | | | While these results are encouraging, pramipexole is |
| direction for researchers and raised hopes for more | | | | not yet approved for the treatment of fibromyalgia |
| efficacious treatments in the future. | | | | syndrome, and in the absence of an approved |
| Currently, the most promising areas of research | | | | prescription product, some fibromyalgia patients have |
| center around central nervous system | | | | turned to natural alternatives (dietary changes, |
| neurotransmittors and the role they play in pain | | | | natural supplements). Foods thought to affect |
| modulation. In the United States, the drugs currently | | | | dopamine levels include almonds, bananas, avocados, |
| approved for the treatment of fibromyalgia | | | | lima beans, pumpkin seeds and sesame seeds. |
| syndrome affect either the neurotransmitters, | | | | Unfortunately, despite anecdotal evidence reporting |
| serotonin and norepinephrine (duloxetine, milnacipran), | | | | positive results, no controlled studies exist to verify |
| or gamma-aminobutyric acid (pregabalin). These are | | | | the efficacy of these efforts. |
| not the only neurotransmitters that are involved in | | | | Though research into the role of central nervous |
| pain modulation, however, leading researchers to look | | | | system neurotransmission in the expression of |
| at the role that dopamine may play in the pathology | | | | fibromyalgia syndrome appears to hold great promise, |
| of fibromyalgia syndrome, too. | | | | the medications currently available are only marginally |
| In fact, there are several good reasons to think that | | | | effective and the need for better therapies is acute. |
| dopamine may play a key role in the etiology and | | | | As research progresses, dopaminergic agents such as |
| clinical presentation of fibromyalgia syndrome: | | | | pramipexole are likely to be added to the growing |
| 1. A link has been identified between fibromyalgia | | | | arsenal of approved agents, hopefully leading to |
| syndrome and an abnormality in a gene responsible | | | | greater relief for a growing number of fibromyalgia |
| for proper dopaminergic expression.(1) This genetic | | | | patients. |
| link suggests that altered dopaminergic pathways | | | | 1. Dan B, Hagit C, Lily N, Ebstein RP. An association |
| may be at least partially responsible for the | | | | between fibromyalgia and the dopamine D4 receptor |
| symptoms of fibromyalgia syndrome. | | | | exon III repeat polymorphism and relationship to |
| 2. Studies utilizing positron emission topography (PET) | | | | novelty seeking personality traits. Molecular |
| to map brain response have empirically shown that | | | | Psychiatry, 2004 9, 730-731. |
| fibromyalgia patients exhibit decreased dopaminergic | | | | 2. Wood PB, Schweinhardt P, Jaeger E, Dagher A, |
| activity in response to painful stimuli when compared | | | | Hakyemez H, Rabiner E, Bushnell MC, Chizh BA. |
| to control groups.(2)(3) These fibromyalgia patients | | | | Fibromyalgia patients show an abnormal dopamine |
| also perceived the painful stimuli to be more severe | | | | response to pain. European Journal of Neuroscience, |
| than did the control group. Since dopamine has been | | | | 2007 June;25(12):3576-3582. |
| implicated in both pain modulation and processing, | | | | 3. Wood P, Patterson II J, Sunderland J, Tainter K, |
| these studies suggest dopamine may be at least | | | | Glabus M, Lilien D. Reduced presynaptic dopamine |
| partially responsible for the widespread pain | | | | activity in fibromyalgia syndrome demonstrated with |
| experienced by fibromyalgia patients. | | | | positron emission tomography: a pilot study. The |
| 3. Anecdotal evidence shows that low dopamine | | | | Journal of Pain, 8(1):51-58. |
| levels are associated with stiff, achy muscles, | | | | 4. Holman AJ, Myers RR. A Randomized, Double-Blind, |
| cognitive impairment, and difficulty focusing. These | | | | Placebo-Controlled Trial of Pramipexole, a Dopamine |
| symptoms are familiar to most fibromyalgia patients. | | | | Agonist, in Patients With Fibromyalgia Receiving |
| These are among the factors that have lead | | | | Concomitant Medications. Arthritis & |
| researchers to conduct clinical trials on the | | | | Rheumatism, 2005 Aug;52(8):2495-2505. |