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Patient Resources - Fibromyalgia

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Fibromyalgia


Topical Ketoprofen For Myalgia
 
Fibromyalgia is defined by the American College of Rheumatology as a chronic pain syndrome in combination with hyperalge­sia (exaggerated pain). It is a common clinical syndrome most often affecting middle-aged women and is characterized by a generalised muscu­loskeletal pain, stiffness, chronic aching, sleep disturbance and fatigue. Tender points are important in the diagnosis of fibromyalgia and are described as specific anatomical sites with reproducible tenderness on pal­pation.
 
These patients often suffer from a disturbance in stage IV sleep, suggested as a possible causative factor in fibromyalgia. Many theories have been suggested for the etiology of this condition, but one of the old­est is the theory that fibromyalgia may be caused by an inflammatory reaction.
 
Nonsteroidal anti-inflammatory drugs are a logical class of drugs to employ in the treatment of fibromyalgia. Nonsteroidal anti-inflammatory drugs such as ketoprofen cause peripheral inhibition of prostaglandin synthesis. Prostaglandins are important me­diators of the inflammatory process; there­fore, nonsteroidal anti-inflammatory drugs are effective in reducing the inflammatory reaction. Nonsteroidal anti-inflammatory drugs also act as analgesic agents, since prostaglandins are also known to sensitise pain receptors.
 
The inhibition of prostaglandins is also responsible for sev­eral other unwanted side effects, such as decreased gastric mucosal cytoprotection, resulting in gastrointestinal (GI) distur­bances, impairment of renal and hepatic function and inhibition of platelet aggre­gation. These are important considerations for patients with chronic disease states or pa­tients who are on multiple medications.
 
Studies show that ketoprofen adminis­tered topically provides the advantages of de­livering the drug directly to the painful site and producing high local drug concentra­tions, while at the same time decreasing the systemic concentration of the drug. Topical administration would prevent most of the GI disturbances commonly encoun­tered during oral nonsteroidal anti-in­flammatory drug therapy.
 
The decreased systemic concentration would also help to prevent hepatic and renal dysfunction, which can be seen with long-term use, and to de­crease the inhibition of platelet aggregation. Therefore, a logical drug therapy regimen for the fibromyalgia patient might include a transdermal nonsteroidal anti-inflamma­tory drug, such as ketoprofen. Direct ap­plication of such a product that leads to reduced inflammation may also ease stiffness, aching and fatigue, thereby greatly im­proving the fibromyalgia patient's overall quality of life.