Fibromyalgia syndrome – Novel therapeutic targets

Fibromyalgia is a syndrome characterized by the presence of chronic widespread pain, representing sensitization of the central nervous system. The pthophysiology of fibromyalgia is a complex and remains in evolution, encompassing diverse issues such as disturbed patterns of sleep, alter processing and decreased conditioned pain modulation at the spinal level, as well as increased connectivity between various pain – processing areas of the brain. This evolution is continuously uncovering potential novel therapeutic targets.Treatment of fibromyalgia is a multi – faceted endeavor, inevitably combining pharmacological as well as non – pharmacological approaches. 2δ ligands and selective nor-epinephrine – serotonin reuptake inhibitors are the current mainstays of pharmacological treatment. Novel re-uptake inhibitors targeting both nor –epinephrine and dopamine are potential additions to this armamentarium as are substance P antagonists, Opiod antagonism is another intriguing possibility. Canabinoid agonists hold promise in the treatment of fibromyalgia although current evidence is incomplete. Sodium Oxybate is a unique sleep – promoting medication while drugs those promot arousals such as modafilnil are also under investigation.In the current review, current and emerging therapeutic options for the syndrome of fibromyalgia are covered.