A team of researchers at Queens University in Ontario, Canada, report discovering a more effective technique for treating fibromyalgia. Results of a trial led by the scientists suggest that combining Lyrica (pregabalin), an anti-seizure drug, with Cymbalta (duloxetine), an antidepressant — drugs that have been proven, individually, to treat fibromyalgia pain — can safely improve patient outcomes.

“Previous evidence supports added benefits with some drug combinations in fibromyalgia,” Dr. Ian Gilron, a professor of Anesthesiology, and Biomedical Sciences, and Director of Clinical Pain Research at the Queen’s Centre for Neuroscience Studies, said in a university press release. “We are very excited to present the first evidence demonstrating superiority of a duloxetine-pregabalin combination over either drug alone.”

The study’s findings are published in the current edition of the journal Pain, in the paper “Combination of pregabalin with duloxetine for fibromyalgia: a randomized controlled trial.“

The investigators explain that their randomized, double-blind, four-period crossover trial compared a pregabalin–duloxetine combination to each drug respectively as a monotherapy. Study participants received maximally tolerated doses of placebo, pregabalin, duloxetine, and the pregabalin–duloxetine combination for six weeks, with results finding that combining pregabalin and duloxetine for fibromyalgia not only provided pain relief, but also improved physical function and overall quality of life. The research team recommends that further research should compare this and other drug combinations to monotherapy for treating fibromyalgia.

While fibromyalgia was initially thought to be a musculoskeletal disorder, according to Gilron and his colleagues, recent research suggests it’s more a central nervous system disorder based in the brain and spinal cord, theorizing that fibromyalgia amplifies painful sensations by altering levels and activity of the brain chemicals responsible for processing pain signals. The syndrome is characterized by chronic widespread pain frequently accompanied by chronic fatigue, disordered sleep, and mood and memory issues.

“The condition affects about 1.5 to 5 per cent of Canadians – more than twice as many women as men. It can have a devastating on the lives of patients and their families,” Gilron said. “Current treatments for fibromyalgia are either ineffective or intolerable for many patients.”

This study, funded by the Canadian Institutes of Health Research (CIHR), is the latest in a series of clinical trials conducted by Gilron and his team on combination therapies to treat chronic pain conditions, with a primary objective to show how physicians can optimize use of current treatments available to patients. “The value of such combination approaches is they typically involve drugs that have been extensively studied and are well known to health-care providers,” Gilron said.

Gilron has co-authored neuropathic pain treatment guidelines for the Canadian Pain Society (2014) and the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (2015) . He is a councillor of the International Association for the Study of Pain and also serves on the executive committee of the Analgesic “ACTTION” partnership. He and his research team at Queen’s are also members of the SPOR Network on Chronic Pain, a national network funded under Canada’s Strategy for Patient-Oriented Research, that directs new research, trains researchers and clinicians, improves access to care for chronic pain sufferers, and speeds up the translation of the most recent research into practice.

Sources:
Queens University
PAIN