Winfried Häuser; Kathrin Bernardy; Nurcan Üçeyler; et al.
Online article and related content current as of November 14, 2010. JAMA. 2009;301(2):198-209 (doi:10.1001/jama.2008.944) http://jama.ama-assn.org/cgi/content/full/301/2/198
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Neurology; Neuromuscular diseases; Pain; Psychiatry; Depression; Psychopharmacology; Quality of Care; Evidence-Based Medicine; Quality of Life; Prognosis/ Outcomes; Drug Therapy; Drug Therapy, Other
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Treatment of Fibromyalgia Syndrome With Antidepressants
Winfried Häuser,MD Kathrin Bernardy, PhD Nurcan Üceyler, MD ¸ Claudia Sommer, MD
IBROMYALGIA SYNDROME (FMS) has an estimated prevalence in North America and Europe of 0.5% to 5.8%.1 According to the criteria of the American College of Rheumatology (ACR), FMS is defined as chronic widespread pain and tenderness at a minimum of 11 of 18 defined tender points.2 Other symptoms of FMS are fatigue and nonrestorativesleep. Most patients report additional somatic and psychological symptoms.3,4 Patients with FMS experience disability and reduced health-related quality of life (HRQOL).5 Fibromyalgia syndrome is also associated with high direct 6,7 and indirect diseaserelated costs.8 Effective treatment of FMS is therefore necessary for medical and economic reasons.9 Whether FMS is a distinct disorder or amanifestation of another underlying disorder is controversial. The spectrum of possible underlying disorders ranges from inflammatory arthritic diseases to depression. Others classify FMS as a functional somatic syndrome.10
Context Fibromyalgia syndrome (FMS) is a chronic pain disorder associated with multiple debilitating symptoms and high disease-related costs. Effective treatment options are needed.Objectives To determine the efficacy of antidepressants in the treatment of FMS by performing a meta-analysis of randomized controlled clinical trials. Data Sources MEDLINE, PsycINFO, Scopus, and the Cochrane Library databases were searched through August 2008. Reference sections of original studies, metaanalyses, and reviews on antidepressants in FMS were reviewed. Study Selection Randomizedplacebo-controlled trials with tricyclic and tetracyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs) were analyzed. Data Extraction and Data Synthesis Two authors independently extracted data. Effects were summarized using standardized mean differences (SMDs) by arandomeffects model. Results Eighteen randomized controlled trials (median duration, 8 weeks; range, 4-28 weeks) involving 1427 participants were included. Overall, there was strong evidence for an association of antidepressants with reduction in pain (SMD, −0.43; 95% confidence interval [CI], −0.55 to −0.30), fatigue (SMD, −0.13; 95% CI, −0.26 to −0.01), depressed mood (SMD, −0.26; 95% CI, −0.39 to −0.12),and sleep disturbances (SMD, −0.32; 95% CI, −0.46 to −0.18). There was strong evidence for an association of antidepressants with improved health-related quality of life (SMD, −0.31; 95% CI, −0.42 to −0.20). Effect sizes for pain reduction were large for TCAs (SMD, −1.64; 95% CI, −2.57 to −0.71), medium for MAOIs (SMD, −0.54; 95% CI, −1.02 to −0.07), and small for SSRIs (SMD, −0.39; 95% CI,...