Nighttime Opioid Combination to Treat Fibromyalgia With PTSD
Patients with PTSD may present with underlying and undiagnosed fibromyalgia, which contributes to poor sleep and further pain amplification.
|The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of Clinical Pain Advisor's conference coverage.|
LAS VEGAS — In patients with concomitant fibromyalgia and posttraumatic stress disorder (PTSD), opioid therapy was shown to improve quality of life and help patients return to a greater sense of "normalcy," according to research presented by James Figueroa, MD, affiliated with the Clinton Hospital in Clinton and Harrington Memorial Hospital in Southbridge, both in Massachusetts, at PAINWeek, held September 5-9.1
Patients with PTSD may present with underlying and undiagnosed fibromyalgia, which contributes to poor sleep and further pain amplification.2 "Persisting fibromyalgia can intensify associated fibrocytic symptoms resulting in worsening of the underlying primary condition, even if that primary condition is not pain associated," explained Dr Figueroa.
Dr Figueroa recommends a nighttime administration of 50 mg tramadol and 4 to 8 mg tizanidine at 7 pm for patients with fibromyalgia and PTSD. The addition of duloxetine, milnacipran, or pregabalin, if used, should be maintained if there is a clinical benefit. He also recommends the addition of 50 mg tapentadol for 2 nights in patients with PTSD to observe potential benefit. Treatment effectiveness, according to Dr Figueroa, is reached when patients achieve no less than 6 hours of uninterrupted, restorative sleep each night.
In >40 women with PTSD treated within the last 5 years, the majority of which had been exposed to domestic violence, Dr Figueroa's treatment resulted in a return to "normalcy" in the lives of the patients and an increase in sleep duration. In addition, the rates of fatigue tender point pain, stiffness, and headache were reduced in this population. Goal accomplishment, employment maintenance, and higher-quality personal relationships were also observed among the patient cohort.
In patients in which treatment failed to alleviate fibromyalgia-related symptoms, no improvements in PTSD were observed. "Fibromyalgia can be intermittently and variably present with the primary clinical entity and can together be looked upon as a singular pathological entity," concluded Dr Figueroa.
Read more of Clinical Pain Advisor's coverage of PAINWeek 2017 by visiting the conference page.
- Figueroa J. Pain, Opioid therapy, Fibromyalgia and PTSD (Post Traumatic Stress Disorder) – A Singular Disease Entity - A Fundamental Concept in Disease Treatment. Presented at: PainWeek 2017; September 5-9, 2017; Las Vegas, NV. Poster 39
- Häuser W, Galek A, Erbslöh-Möller B, et al. Posttraumatic stress disorder in fibromyalgia syndrome: prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome. Pain. 2013;154(8):1216-1223.