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Fibromyalgia and Savella (milnacipran hydrochloride): An Overview for the Pharmacist

Kathryn L. Hahn, PharmD, CPE, DAAPM
Published Online: Friday, October 15, 2010

Introduction
Fibromyalgia (FM) is a multisymptom condition characterized by chronic widespread pain, functional disability, physical deconditioning, and a variety of other symptoms. FM has emerged as a major diagnostic source of prescriptions for analgesics, muscle relaxants, reuptake inhibitors, and other medications. Standards for diagnosis and treatment remain controversial in the medical community. Increasing evidence supports FM as a specific physical condition with demonstrated chemical abnormalities and physiologic processes that differ from other illnesses and those in healthy control subjects. Recent laboratory, positron emission tomography, voxel-based morphometry, and functional magnetic resonance imaging (fMRI) research has supported the legitimacy of FM as a genuine, distinct disorder. Nevertheless, that legitimacy is still not universally accepted, perhaps in part because FM cannot be diagnosed with a simple laboratory test.

FM is more prevalent than some pharmacists and physicians are aware. In the United States, approximately 2% to 4% of the population suffers from FM, and up to 73% of patients are undiagnosed. Controversy in the medical community about the definition and diagnosis of FM, along with societal stigma attached to psychophysical symptoms, make FM an especially harsh condition for those who suffer from it. Patients may meet the criteria for FM without receiving an accurate diagnosis for years. The frustrating lack of diagnosis and physician skepticism can cause greater distress. It is not surprising that many patients are confused about their condition, or that medication adherence is generally poor.

Community pharmacists can play an important role in helping to identify patients with FM and assisting clinicians with rational treatment plans that incorporate the most effective treatments for the individual patient while minimizing adverse effects and avoiding drug–drug interactions. Education and counseling from pharmacists can help patients understand FM, gain control over the stressors that cause flareups, and more successfully manage symptoms. Importantly, through patient counseling, pharmacists can promote medication adherence and thus enable better treatment outcomes.

This monograph will explore the symptoms and diagnosis of FM; epidemiology, burden, and pathophysiology; and pharmacologic and nonpharmacologic treatment options. In addition, it will provide a comprehensive description of milnacipran HCl, including its clinical pharmacology, clinical efficacy, dosing, and safety information. Lastly, it will offer practical information on the role of the pharmacist in the care of patients with FM.

For access to the monograph, click here or icon above.

This supplement was supported by Forest Pharmaceuticals, Inc.
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