Role and rationale for the use of milnacipran in the management of fibromyalgia

Jay D Kranzler, R Michael GendreauCypress Bioscence, San Diego, CA, USAAbstract: Fibromyalgia (FM) is a complex syndrome characterized by chronic widespread musculoskeletal pain which is often accompanied by multiple other symptoms, including fatigue, sleep disturbances, decreased physical functioni...

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Autores principales:	Jay D Kranzler, R Michael Gendreau
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2010
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/48dd7cbd79a54dac83bbcdbbaefe92f3
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spelling	oai:doaj.org-article:48dd7cbd79a54dac83bbcdbbaefe92f32021-12-02T06:51:21ZRole and rationale for the use of milnacipran in the management of fibromyalgia1176-63281178-2021https://doaj.org/article/48dd7cbd79a54dac83bbcdbbaefe92f32010-04-01T00:00:00Zhttp://www.dovepress.com/role-and-rationale-for-the-use-of-milnacipran-in-the-management-of-fib-a4339https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Jay D Kranzler, R Michael GendreauCypress Bioscence, San Diego, CA, USAAbstract: Fibromyalgia (FM) is a complex syndrome characterized by chronic widespread musculoskeletal pain which is often accompanied by multiple other symptoms, including fatigue, sleep disturbances, decreased physical functioning, and dyscognition. Due to these multiple symptoms, as well as high rates of comorbidity with other related disorders, patients with FM often report a reduced quality of life. Although the pathophysiology of FM is not completely understood, patients with FM experience pain differently from the general population, most likely due to dysfunctional pain processing in the central nervous system leading to both hyperalgesia and allodynia. In many patients with FM, this aberrant pain processing, or central sensitization, appears to involve decreased pain inhibition within the spinal tract, which is mediated by descending pathways that utilize serotonin, norepinephrine, and other neurotransmitters. The reduced serotonin and norepinephrine levels observed in patients with FM suggest that medications which increase the levels of these neurotransmitters, such as serotonin and norepinephrine reuptake inhibitors (SNRIs), may have clinically beneficial effects in FM and other chronic pain conditions. Milnacipran is an SNRI that has been approved for the management of FM. In clinical trials, treatment with milnacipran for up to 1 year has been found to improve the pain and other symptoms of FM. Because FM is characterized by multiple symptoms that all contribute to the decreased quality of life and ability to function, the milnacipran pivotal trials implemented responder analyses. These utilized a single composite endpoint to identify the proportion of patients who reported simultaneous and clinically significant improvements in pain, global disease status, and physical function. Other domains assessed during the milnacipran trials include fatigue, multidimensional functioning, mood, sleep quality, and patient-reported dyscognition. This review article provides information intended to help clinicians make informed decisions about the use of milnacipran in the clinical management of patients with FM. It draws primarily on results from 2 of the pivotal clinical trials that formed the basis of approval of milnacipran in the United States by the Food and Drug Administration.Keywords: fibromyalgia, milnacipran, pain, serotonin and norepinephrine reuptake inhibitors, SNRI Jay D KranzlerR Michael GendreauDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2010, Iss Issue 1, Pp 197-208 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Jay D Kranzler R Michael Gendreau Role and rationale for the use of milnacipran in the management of fibromyalgia
description	Jay D Kranzler, R Michael GendreauCypress Bioscence, San Diego, CA, USAAbstract: Fibromyalgia (FM) is a complex syndrome characterized by chronic widespread musculoskeletal pain which is often accompanied by multiple other symptoms, including fatigue, sleep disturbances, decreased physical functioning, and dyscognition. Due to these multiple symptoms, as well as high rates of comorbidity with other related disorders, patients with FM often report a reduced quality of life. Although the pathophysiology of FM is not completely understood, patients with FM experience pain differently from the general population, most likely due to dysfunctional pain processing in the central nervous system leading to both hyperalgesia and allodynia. In many patients with FM, this aberrant pain processing, or central sensitization, appears to involve decreased pain inhibition within the spinal tract, which is mediated by descending pathways that utilize serotonin, norepinephrine, and other neurotransmitters. The reduced serotonin and norepinephrine levels observed in patients with FM suggest that medications which increase the levels of these neurotransmitters, such as serotonin and norepinephrine reuptake inhibitors (SNRIs), may have clinically beneficial effects in FM and other chronic pain conditions. Milnacipran is an SNRI that has been approved for the management of FM. In clinical trials, treatment with milnacipran for up to 1 year has been found to improve the pain and other symptoms of FM. Because FM is characterized by multiple symptoms that all contribute to the decreased quality of life and ability to function, the milnacipran pivotal trials implemented responder analyses. These utilized a single composite endpoint to identify the proportion of patients who reported simultaneous and clinically significant improvements in pain, global disease status, and physical function. Other domains assessed during the milnacipran trials include fatigue, multidimensional functioning, mood, sleep quality, and patient-reported dyscognition. This review article provides information intended to help clinicians make informed decisions about the use of milnacipran in the clinical management of patients with FM. It draws primarily on results from 2 of the pivotal clinical trials that formed the basis of approval of milnacipran in the United States by the Food and Drug Administration.Keywords: fibromyalgia, milnacipran, pain, serotonin and norepinephrine reuptake inhibitors, SNRI
format	article
author	Jay D Kranzler R Michael Gendreau
author_facet	Jay D Kranzler R Michael Gendreau
author_sort	Jay D Kranzler
title	Role and rationale for the use of milnacipran in the management of fibromyalgia
title_short	Role and rationale for the use of milnacipran in the management of fibromyalgia
title_full	Role and rationale for the use of milnacipran in the management of fibromyalgia
title_fullStr	Role and rationale for the use of milnacipran in the management of fibromyalgia
title_full_unstemmed	Role and rationale for the use of milnacipran in the management of fibromyalgia
title_sort	role and rationale for the use of milnacipran in the management of fibromyalgia
publisher	Dove Medical Press
publishDate	2010
url	https://doaj.org/article/48dd7cbd79a54dac83bbcdbbaefe92f3
work_keys_str_mv	AT jaydkranzler roleandrationalefortheuseofmilnacipraninthemanagementoffibromyalgia AT rmichaelgendreau roleandrationalefortheuseofmilnacipraninthemanagementoffibromyalgia
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Role and rationale for the use of milnacipran in the management of fibromyalgia

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