Pramipexole For Fibromyalgia
Dopaminergic Agents As Fibromyalgia Therapy
The treatment of fibromyalgia syndrome appears to be entering something of a golden age. Recently, after years of struggling just to be taken seriously, fibromyalgia patients have witnessed the release of a series of medications indicated for the treatment of fibromyalgia syndrome. While it is true that these medications are far from perfect and aren’t effective for everyone, they have provided a strong sense of direction for researchers and raised hopes for more efficacious treatments in the future.
Currently, the most promising areas of research center around central nervous system neurotransmittors and the role they play in pain modulation. In the United States, the drugs currently approved for the treatment of fibromyalgia syndrome affect either the neurotransmitters, serotonin and norepinephrine (duloxetine, milnacipran), or gamma-aminobutyric acid (pregabalin). These are not the only neurotransmitters that are involved in pain modulation, however, leading researchers to look at the role that dopamine may play in the pathology of fibromyalgia syndrome, too.
In fact, there are several good reasons to think that dopamine may play a key role in the etiology and clinical presentation of fibromyalgia syndrome:
1. A link has been identified between fibromyalgia syndrome and an abnormality in a gene responsible for proper dopaminergic expression.(1) This genetic link suggests that altered dopaminergic pathways may be at least partially responsible for the symptoms of fibromyalgia syndrome.
2. Studies utilizing positron emission topography (PET) to map brain response have empirically shown that fibromyalgia patients exhibit decreased dopaminergic activity in response to painful stimuli when compared to control groups.(2)(3) These fibromyalgia patients also perceived the painful stimuli to be more severe than did the control group. Since dopamine has been implicated in both pain modulation and processing, these studies suggest dopamine may be at least partially responsible for the widespread pain experienced by fibromyalgia patients.
3. Anecdotal evidence shows that low dopamine levels are associated with stiff, achy muscles, cognitive impairment, and difficulty focusing. These symptoms are familiar to most fibromyalgia patients.
These are among the factors that have lead researchers to conduct clinical trials on the dopaminergic agent, pramipexole, with intriguing results. Compared with the control group, patients in this study experienced gradual, significant improvement in measurements of pain, fatigue, function, and overall well-being, suggesting that dopaminergic agents may be of value in the treatment of fibromyalgia syndrome.
While these results are encouraging, pramipexole is not yet approved for the treatment of fibromyalgia syndrome, and in the absence of an approved prescription product, some fibromyalgia patients have turned to natural alternatives (dietary changes, natural supplements). Foods thought to affect dopamine levels include almonds, bananas, avocados, lima beans, pumpkin seeds and sesame seeds. Unfortunately, despite anecdotal evidence reporting positive results, no controlled studies exist to verify the efficacy of these efforts.
Though research into the role of central nervous system neurotransmission in the expression of fibromyalgia syndrome appears to hold great promise, the medications currently available are only marginally effective and the need for better therapies is acute. As research progresses, dopaminergic agents such as pramipexole are likely to be added to the growing arsenal of approved agents, hopefully leading to greater relief for a growing number of fibromyalgia patients.
1. Dan B, Hagit C, Lily N, Ebstein RP. An association between fibromyalgia and the dopamine D4 receptor exon III repeat polymorphism and relationship to novelty seeking personality traits. Molecular Psychiatry, 2004 9, 730-731.
2. Wood PB, Schweinhardt P, Jaeger E, Dagher A, Hakyemez H, Rabiner E, Bushnell MC, Chizh BA. Fibromyalgia patients show an abnormal dopamine response to pain. European Journal of Neuroscience, 2007 June;25(12):3576-3582.
3. Wood P, Patterson II J, Sunderland J, Tainter K, Glabus M, Lilien D. Reduced presynaptic dopamine activity in fibromyalgia syndrome demonstrated with positron emission tomography: a pilot study. The Journal of Pain, 8(1):51-58.
4. Holman AJ, Myers RR. A Randomized, Double-Blind, Placebo-Controlled Trial of Pramipexole, a Dopamine Agonist, in Patients With Fibromyalgia Receiving Concomitant Medications. Arthritis & Rheumatism, 2005 Aug;52(8):2495-2505.
Author: L Payton
Larry Payton is a biochemist and pharmacist with over 10 years of practical experience. His current passion involves developing the Myalganex System, nutritional supplements designed specifically for the fibromyalgia patient.
Article Source: http://EzineArticles.com/?expert=L_Payton
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