Evolución de los síntomas dolorosos y depresivos en pacientes con
fibromialgia. Respuestas al tratamiento combinado con inhibidores
selectivos de la recaptación de serotonina y benzodiazepinas.
Conclusiones El
Conclusiones El tratamiento farmacológico combinado con I.S.R.S. y BZD produce una mejoría concomitante de los síntomas dolorosos y depresivos en pacientes con fibromialgia en nuestro medio, produciendo mejoría en ambas series sintomáticas en más del 80% de los casos estudiados. Existe una alta comorbilidad de fibromialgia con trastornos psíquicos. En algunos casos las evaluaciones muestran síntomas mentales depresivos leves o ausentes, que hacen necesario explicar al paciente y su familia, la utilidad de la prescripción para lograr mayor adhesión al tratamiento. Referencias Bibliográficas 1- Aaron LA, Bradley LA, Alarcón GS, Alexander RW, Triana-Alexander M, Martin MY, et al. Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behavior rather than to illness. Arthritis Rheum 1996; 39(3): 436-445. 2- Birket-Smith M, Mortensen E. Pain in somatoform disorders: is somatoform pain disorder a valid diagnosis?. Acta Psychiatr Scand 2002; 106 (2): 103-108. 3- Cantini F, Bellandi F, Niccoli L, Di Munno O. Fluoxetin combined with cyclobenzaprine in the treatment of fibromyalgia (in Italian). Minerva Medica 1994; 85(3): 97-100. 4- Carette S, McCain GA, Bell DA, Fam AG. Evaluation of amitriptyline in primary fibrositis: a double-blind, placebo-controlled study. Arthritis Rheum 1986; 29(5): 655-659. 5- Carette S, Bell MJ, Reynolds WJ, Haraoui B, McCain GA, Bykerk VP, et al. Comparison of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia: a randomized, double-blind clinical trial. Arthritis Rheum 1994; 37(1): 32-40. 6- Carette S, Oakson G, Guimont C, Steriade M. Sleep electroencephalography and the clinical response to amitriptyline in patients with fibromyalgia. Arthritis Rheum 1995; 38(9): 1211-1217. 7- Carrera JQ, Castano AV, Gomez JP, Rodriguez AF, Medano WH, Rubeio AG, et al. Comparison of tenoxican and bromazepam in the treatment of fibromyalgia: a randomized, double-blind, placebo controlled trial. Pain 1996; 65: 221-225. 8- Gilbody S, House AO. Routinely administered questionnaires for depression and anxiety: systematic review. BMJ 2001; 322(7283): 406-409. 9- Goldenberg DL, Felson DT, Dinerman H. A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum 1986; 29(11): 1371-1377. 10- Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmic C. A randomized double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum 1996; 39(11): 1852-1859. 11- Margues et al. Pain evaluation of patients with fibromyalgia, osteoarthritis, and low back pain. Rev Hosp Clín Fac Med S Paulo 2001; 56(1): 5-10. 12- Norregaard J, Volkmann H, Danneskiold-Samsoe B. A randomized controlled trial of citalopram in the treatment of fibromyalgia. Pain 1995; 61(3): 445-449. 13- O'Malley PG, Jackson JL, Santoro J, Tomkins G, Balden E, Kroenke K. Antidepressant therapy for unexplained symptoms and symptom syndromes. Journal of Family Practice 1999; 48(12): 980-990. 14- Pignone M, Gaynes BN, Rushton JL. Screening for Depression in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force. Annals of Intern Med 2002; 136(10): 765-776. 15- Revista Española de Reumatología 2000; 27(10). (Fibromialgia). 16- Russell IJ, Fletcher EM, Michalek JE, McBroom PC, Hester GG. Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam: a double-blind, placebo-controlled study. Arthritis Rheum 1991; 34(5): 552-560. 17- Schulberg HC, Block MR, Madionia MJ, Rodríguez E, Scott CP, Lave J. Applicability of Clinical Pharmacotherapy Guidelines for Major Depression in Primary Care Settings. Arch Fam Med 1995; 4(2): 106-112. 18- Scudds RA, McCain GA, Rollman GB, Harth M. Improvements in pain responsiveness in patients with fibrositis after successful treatment with amitriptyline. J Rheumatol 1989; 19: 98-103. 19- Simon,GE, VonKorff M, Piccinelli M Fullerton C, Ormel J. An Internatinal Study of the relation between Somatic Symptoms and Depression. N Engl J Med 1999; 341(18): 1329-1335. 20- Wolfe F, Smythe HA,Yunus MB, Bennett RM, Bombardier C, Goldenberg DI et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33(2): 160-172. 21- Wolfe F, Cathey MA, Hawley DJ. A double-blind placebo controlled trial of fluoxetine in fibromyalgia. Scand J Rheumatol 1994; 23(5): 255-259. 22- Wolfe F, Anderson J, Harkness D, Bennett RM, Caro XJ, Goldenberg DL, et al. A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia (see comments). Arthritis Rheum 1997; 40(9): 1560-1570.
