Abstract

ACIN, M. P.  and  ESCARTIN, R.. Gabapentin for the management of fibromyalgia. Rev. Soc. Esp. Dolor [online]. 2005, vol.12, n.4, pp.211-216. ISSN 1134-8046.

Objectives: Fibromyalgia is one of the most common causes of local or widespread chronic musculoskeletal pain that is characterized by the presence of painful anatomical points, morning rigidity, easy fatigue, sleep disorders and other related symptoms. Some authors claim that fibromyalgia is due to an abnormal processing of pain at the central nervous system and has a neuropathic component. A deficit in the release of serotonin and other substances involved in the regulation of nociceptive processes has also been shown. In this study we determined the effectiveness of gabapentin in patients diagnosed of fibromyalgia. Material and method: We studied 24 patients, all of them women with a mean age of 42.54 ± 13.08 (33-60). Fifty per cent (12) had cervical pain and 50% (12), cervical and lumbar pain as the main painful symptoms. Fifteen patients were being treated with NSAIDs, 12 with tramadol, 2 with fentanyl TTS, 9 with sedatives, 9 with antidepressants, 1 with buprenorphin TDS, 14 with physiotherapy, 13 with injection of local anesthetic at the trigger points and 1 with iontophoresis. These therapies had somewhat improved their condition, so they were maintained unchanged and gabapentin was added as anticonvulsant monotherapy. Pain severity was assessed through VAS, Lattinen´s test, physical activity and night rest, before the start and after 9 months of treatment with gabapentin. Initial and final daily doses, analgesic assessment before and after treatment and side effects during this period were recorded. A descriptive statistical study was conducted using the Statview SE Graphics software. Results: Results are based on VAS scores: the initial mean VAS score was 5.2 ± 1.5 (R 3-8) and the final mean VAS score was 3.2 ± 1.3 (R 2-7). Eight patients (33.33%) reported improved physical activity and 10 (41.6%), improved quality of sleep. Pain relief was satisfactory in 37.5% (9) of patients, moderate in 41.6% (10) and poor in 16.6% (4). Treatment had to be discontinued due to side effects in 4.16% (1). Initial daily mean dose of gabapentin was 300 mg.day^-1 and final daily mean dose, 762.5 ± 409.46 mg.day^-1. The average length of treatment was 9.04 ± 6.7 months. Side effects appeared in 9 patients (37.5%), with dizziness in 6 (25%), lack of stability in 2 (8.33%) and discontinuation of treatment due to excessive somnolence in 1. At the end of the study, 23 patients were still being treated, 4 of them with low doses (300 mg/day) due to side effects. Conclusions: Patients with fibromyalgia are frequently managed with different therapies and poor results. Although our series included cases in which satisfactory analgesic control was achieved with low doses, further comparative studies are required in order to obtain additional data to better assess these results.

Keywords : Chronic pain; Fibromyalgia; Anticonvulsant drugs; Gabapentin.

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