Neurontin and fibromyalgia
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Neurontin (Gabapentin) is a second-generation anticonvulsant medication (U.S. FDA 1993), approved for the treatment of epileptic seizures.
Anticonvulsants are believed to work in part by by enhancing the actions of a natural brain chemical, GABA (gamma-aminobutyric acid). GABA is a neurotransmitter, a chemical that carries messages between brain nerve cells. GABA inhibits the transmission of nerve signals, thereby reducing nervous excitation.
Like other anticonvulsant medications, Gabapentin may be effective in treating conditions as varied as mood and anxiety disorders, sleep disorders, preventing migraine headaches and reducing chronic, neuropathic pain. In terms of pain relief, Gabapentin appears to be at least as effective as the tricyclic antidepressants, like amitriptyline, but has a much better safety profile with fewer potential drug interactions and side effects. Fibromyalgia patients may also benefit from its positive effect on slow wave sleep and its effectiveness in reducing restless leg syndrome. Sleepiness, dizziness, and problems with coordination are the most commonly reported side effects.
[NOTE: Pregabalin, , a derivative of Gabapentin, has been approved in the European Community (July 2004) and the U.S. FDA (September 2004) for the treatment of epilepsy and painful diabetic neuropathy. Because it is more potent than Gabapentin, Pregabalin achieves effectiveness at lower doses. This increases its therapeutic index with respect to Gabapentin and should lead to fewer dose-related side effects.
In October 2002, at the annual meeting of the American College of Rheumatology, Pfizer presented data on a clinical trial on Pregabalin for the treatment of FMS. According to this trial, Pregabalin was significantly better than placebo in relieving pain, and it also significantly improved sleep quality and fatigue.] Pregabalin (Lyrica) has since been approved by the FDA for the treatment of fibromyalgia.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases, funded a study which assessed the effectiveness of gabapentin in reducing the symptoms of fibromyalgia syndrome (FMS). Gabapentin, which is the generic form of Neurontin, is an anticonvulsant medication. The drug has also been found to relieve chronic pain caused by nervous system disorders, and was most recently approved by the FDA for the treatment of persistent, severe pain associated with shingles.
Fibromyalgia is a chronic disorder with symptoms which include widespread musculoskeletal pain and fatigue. Treatment of fibromyalgia typically engages a comprehensive approach, combining exercise, medication, and physical therapy.
Currently no medications are specifically approved by the FDA for the treatment of fibromyalgia. To treat the symptoms of FMS, many people are prescribed:
nonsteroidal anti-inflammatory drugs (NSAIDS)
Depending on the study results, gabapentin is another treatment option for the estimated 3 to 6 million Americans affected by FMS. Mostly seen in women, FMS can affect children and men as well.
The new study will be conducted by Lesley M. Arnold, M.D. and colleagues at the University of Cincinnati College of Medicine, and two Boston area sites, McLean Hospital of Harvard University and Newton-Wellesley Hospital. Approximately 150 study participants with FMS will be randomly assigned to take either gabapentin or a placebo for a 12-week period. The effectiveness of the medication will be evaluated using questionnaires that assess:
tender point pain threshold*
quality of life
*Tender points are specific places on the body, located on the neck, shoulders, back, hips, and upper and lower extremities, where people with FMS often feel pain in response to slight pressure.
Get more information about neurontin and fibromyalgia and related issues as well as...
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