Exercise and antidepressants improve fibromyalgia

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Applied Evidence

Exercise and antidepressants improve fibromyalgia

J Fam Pract. 2004 April;53(4):280-291

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References

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Medication. Consider a trial of amitriptyline, 25 to 50 mg every night, for up to 6 weeks (SOR A). A caveat: tricyclic antidepressants may also have significant side effects, which could outweigh moderate benefits. Moreover, treatment effectiveness beyond 2 months has not been proven. Therefore, longitudinal measurement of outcomes should be part of ongoing care.

Follow-up. Studies have not determined which measures are best to follow (see “Assessing treatment efficacy”), but they might include the following (SOR: C):

Pain (eg, visual analogue scale, pain drawings)
Number of tender points, and tenderness
Physical function (eg, cardiorespiratory fitness, self-reported physical function measured by the physical-impairment subscale of the FIQ,⁵⁶ strength)
Global well-being or perceived improvement (eg, physician-rated change, FIQ total score)
Self-efficacy (eg, Arthritis Self-efficacy Questionnaire)
Fatigue and sleep (eg, FIQ fatigsubscale, sleep visual analogue scale)
Psychological function (eg, FIQ subscales for depression and anxiety)
Ability to work
Health care consumption and costs.^47,50

Education or psychological coping strategies may also contribute positively to overall patient and family well-being. Consider education/psychological counseling (SOR: C) and acupuncture (SOR: B).

Assessing treatment efficacy: Outcome tools online

The Fibromyalgia Impact Questionnaire: myalgia.com/Paintools/fibromyalgia_impact_questionnair1.htm

Visual analogue pain scale: www.outcomesassessment.org/QVAS%20Form.pdf

Arthritis Self-Efficacy Questionnaire: patienteducation.stanford.edu/research/searthritis.pdf

Acknowledgments

The authors would like to express their appreciation to Cheryl Mongillo, Peggy Lardear, and Brian Pellini for their assistance in preparing the manuscript as well as Dolores Moran and Diane Wolf for their library assistance, and to James Newman, MD, rheumatologist, for his expert suggestions. Funding for this project was provided by a grant from the Delaware Department of Health and Social Services, Division of Public Health.of Health and Social Services, Division of Public Health.

Drug brand names

Amitripyline • Elavil
Citalopram • Celexa
Clomipramine • Anafranil
Cyclobenzaprine • Flexeril
Dothiepin • Prothiaden
Fluoxetine • Prozac
Maprotiline • Ludoimil

Corresponding author
Anna Quisel, MD, c/o Cheryl Mongillo, Department of Family and Community Medicine, Christiana Care Health Systems, 1401 Foulk Road, Wilmington, DE 19803. E-mail: bretandanna@comcast.net.