علاج الفيبروميالجيا مع اضطراب النوم الشديد

References

DOI: 10.1136/annrheumdis-2016-209724

• Pharmacological therapies (all 'weak for') should be considered for those with severe pain (duloxetine, pregabalin, tramadol) or sleep disturbance (amitriptyline, cyclobenzaprine, pregabalin).
• Nishishinya et al in their high-quality review concluded that 25 mg/day improved pain, sleep and fatigue at 6–8 weeks of treatment but not at 12 weeks while 50 mg/day did not demonstrate efficacy.
• Häuser et al reported that patients receiving amitriptyline were more likely to achieve 30% pain reduction (risk ratio (RR) 1.60, 95% CI 1.15 to 2.24), equivalent to a 'number needed to treat' (NNT) of 3.54, 95% CI 2.74 to 5.01.
• There was a moderate effect on sleep (standardised mean difference (SMD) −0.56, 95% CI −0.78, to −0.34) and small effect on fatigue (−0.44; −0.71 to −0.16).