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Antipsychotics for Fibromyalgia in Adults

 

Am Fam Physician. 2017 Aug 1;96(3):online.

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ANTIPSYCHOTICS FOR FIBROMYALGIA IN ADULTS

BenefitsHarms

1 in 8 had at least a 30% reduction in pain

1 in 12 gained 11 lb (5 kg) or more

1 in 4 had a reduction in sleep problems

1 in 6 had a reduction in depressed mood

1 in 5 had a clinically significant improvement in quality of life

ANTIPSYCHOTICS FOR FIBROMYALGIA IN ADULTS

BenefitsHarms

1 in 8 had at least a 30% reduction in pain

1 in 12 gained 11 lb (5 kg) or more

1 in 4 had a reduction in sleep problems

1 in 6 had a reduction in depressed mood

1 in 5 had a clinically significant improvement in quality of life

Details for This Review

Study Population: Adults with fibromyalgia

Efficacy End Points: At least 30% reduction in pain; reduction in depressed mood; reduction in sleep problems; clinically significant improvement in quality of life

Harm End Points: Any adverse event including weight gain and participants dropping out because of an adverse effect

Narrative: Fibromyalgia is characterized by chronic, widespread musculoskeletal pain, often associated with fatigue, memory problems, and sleep disturbances.1 However, ongoing research suggests it is a disorder of pain regulation or central sensitization.2 Up to 70% of patients with fibromyalgia also meet criteria for depression or anxiety, so medications for these conditions are often used to treat fibromyalgia.

This Cochrane review evaluated the evidence available for the use of antipsychotics, specifically quetiapine (Seroquel), to treat fibromyalgia.3 A total of four studies with 296 participants were reviewed. Three studies compared the use of quetiapine at bedtime with placebo (n = 206), and the fourth study (n = 90) compared quetiapine with amitriptyline. For the primary measured outcome of at least 50% reduction in pain, quetiapine was not statistically more effective than the control. For the secondary outcome, reduction of pain by at least 30%, two studies (n = 155) found a statistically significant benefit. Twenty of 82 participants (24.4%) receiving quetiapine and eight of 73 participants (11.0%) receiving a placebo reported pain relief of at least 30% (risk difference [RD] = 0.12%; 95% confidence interval [CI], 0.00 to 0.23; P = .04). The number needed to treat (NNT) for an additional person to benefit was 8 (95% CI, 5 to 100).

In two studies (n = 87), there was evidence that quetiapine was superior to placebo in reducing sleep problems, another secondary end point (standardized mean difference [SMD] = −0.67; 95% CI, −1.10 to −0.23; P = .003; NNT = 4).

Three studies (n = 207) were evaluated in an analysis

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547–1555....

2. Schmidt-Wilcke T, Kairys A, Ichesco E, et al. Changes in clinical pain in fibromyalgia patients correlate with changes in brain activation in the cingulate cortex in a response inhibition task. Pain Med. 2014;15(8):1346–1358.

3. Walitt B, Klose P, Üçeyler N, Phillips T, Häuser W. Antipsychotics for fibromyalgia in adults. Cochrane Database Syst Rev. 2016;(6):CD011804

4. Bennett RM, Bushmakin AG, Cappelleri JC, Zlateva G, Sadosky AB. Minimal clinically important difference in the fibromyalgia impact questionnaire. J Rheumatol. 2009;36(6):1304–1311.

 

 

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