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World J Pharmacology. Mar 9, 2017; 6(1): 1-10
Published online Mar 9, 2017. doi: 10.5497/wjp.v6.i1.1
Emerging pharmacological strategies for the treatment of fibromyalgia
Kim Lawson
Kim Lawson, Department of Biosciences and Chemistry, Biomolecular Sciences Research Centre, Sheffield Hallam University, Faculty of Health and Wellbeing, Sheffield S1 1WB, United Kingdom
Author contributions: Lawson K researched the materials for the article and wrote the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with the author for the contributions in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kim Lawson, BTech(Hons), PhD, Senior Lecturer, Department of Biosciences and Chemistry, Biomolecular Sciences Research Centre, Sheffield Hallam University, Faculty of Health and Wellbeing, City Campus, Sheffield S1 1WB, United Kingdom. k.lawson@shu.ac.uk
Telephone: +44-114-2253057 Fax: +44-114-2253066
Received: October 29, 2016
Peer-review started: November 2, 2016
First decision: December 1, 2016
Revised: January 6, 2017
Accepted: February 8, 2017
Article in press: February 10, 2017
Published online: March 9, 2017
Processing time: 124 Days and 7.8 Hours
Abstract

Fibromyalgia (FM) has been described as a chronic clinical condition related to multisensory hypersensitivity presenting with a complex of symptoms dominated by chronic widespread pain associated with the existence of a range of co-morbidities, such as fatigue, sleep disturbance, cognitive impairment, anxiety and depression. Current treatments include drugs that target serotonin and noradrenaline levels within the central nervous system, e.g., tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, and voltage-gated calcium channel subunit ligands, e.g., gabapentin and pregabalin. Investigation of a range of novel targets, such as melatoninergic, cannabinoid, dopamine, NMDA, angiotensin, orexin and opioid receptors, and ion channels, in addition revisiting bioamine modulation and subunits has provided efficacy outcomes that improve the health status of patients with FM. Nevertheless, modest and limited efficacy is often observed reflecting the heterogeneity of FM with existence of subpopulations of patients, the contribution of peripheral and central components to the pathophysiology, and the extensive range of accompanying co-morbidities. The complexity and multidimensional nature of FM is emphasized by the diversity of pharmacological targets gaining interest. Clues to underlying mechanisms which offer themselves as novel and potential targets for new medications are being provided by advances in the understanding of the pathophysiology of FM.

Keywords: Fibromyalgia; Chronic pain; Fatigue; Central sensitization; NMDA receptors; Melatonin receptors; Gabapentanoids

Core tip: Fibromyalgia (FM) is a multidimensional chronic pain condition that current therapies provide modest and limited efficacy due to the heterogeneity of the condition, contribution of peripheral and central components to the pathophysiology, and a range of co-morbidities. Drugs acting on novel and existing targets, such as melatoninergic, cannabinoid, dopamine, NMDA, angiotensin, orexin and opioid receptors, ion channels, bioamine processes and subunits have provided efficacy outcomes that improve the health status of patients with FM. An understanding of the pathophysiology of FM is providing potential targets for new medications.