While no clinical trial to date has specifically targeted fatigue , r and omized controlled trials , systematic review s , and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue .
Fatigue is a disabling , multifaceted symptom that is highly prevalent and stubbornly persistent .
Although fatigue is a frequent complaint among patients with fibromyalgia , it has not received the same attention as pain .
Reasons for this include lack of st and ardized nomenclature to communicate about fatigue , lack of evidence -based guidelines for fatigue assessment , and a deficiency in effective treatment strategies .
Fatigue does not occur in isolation ; rather , it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain , unrefreshing sleep , anxiety , depression , cognitive difficulties , and so on .
Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms .
A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications.
OBJECTIVE To assess the efficacy and safety of pramipexole , a dopamine 3 receptor agonist , in patients with fibromyalgia . METHODS In this 14-week , single-center , double-blind , placebo-controlled , parallel-group , escalating-dose trial , 60 patients with fibromyalgia were r and omized 2:1  ( pramipexole : placebo ) to receive 4.5 mg of pramipexole or placebo orally every evening . The primary outcome was improvement in the pain score ( 10-cm visual analog scale [ VAS ] ) at 14 weeks . Secondary outcome measures were the Fibromyalgia Impact Question naire ( FIQ ) , the Multidimensional Health Assessment Question naire ( MDHAQ ) , the pain improvement scale , the tender point score , the 17- question Hamilton Depression Inventory ( HAM-d ) , and the Beck Anxiety Index ( BAI ) .  Patients with comorbidities and disability were not excluded . Stable dosages of concomitant medications , including analgesics , were allowed . RESULTS Compared with the placebo group , patients receiving pramipexole experienced gradual and more significant improvement in measures of pain , fatigue , function , and global status . At 14 weeks , the VAS pain score decreased 36 % in the pramipexole arm and 9 % in the placebo arm ( treatment difference -1.77 cm ) . Forty-two percent of patients receiving pramipexole and 14 % of those receiving placebo achieved > or = 50 % decrease in pain . Secondary outcomes favoring pramipexole over placebo included the total FIQ score ( treatment difference -9.57 ) and the percentages of improvement in function ( 22 % versus 0 % ) , fatigue ( 29 % versus 7 % ) , and global ( 38 % versus 3 % ) scores on the MDHAQ . Compared with baseline , some outcomes showed a better trend for pramipexole treatment than for placebo , but failed to reach statistical significance , including improvement in the tender point score ( 51 % versus 36 % ) and decreases in the MDHAQ psychiatric score ( 37 % versus 28 % ) , the BAI score ( 39 % versus 27 % ) , and the HAM-d score ( 29 % versus 9 % ) . No end points showed a better trend for the placebo arm . The most common adverse events associated with pramipexole were transient anxiety and weight loss . No patient withdrew from the study because of inefficacy or an adverse event related to pramipexole . CONCLUSION In a subset of patients with fibromyalgia , approximately 50 % of whom required narcotic analgesia and /or were disabled , treatment with pramipexole improved scores on assessment s of pain , fatigue , function , and global status , and was safe and well-tolerated
While no clinical trial to date has specifically targeted fatigue , r and omized controlled trials , systematic review s , and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue .
Fatigue is a disabling , multifaceted symptom that is highly prevalent and stubbornly persistent .
Although fatigue is a frequent complaint among patients with fibromyalgia , it has not received the same attention as pain .
Reasons for this include lack of st and ardized nomenclature to communicate about fatigue , lack of evidence -based guidelines for fatigue assessment , and a deficiency in effective treatment strategies .
Fatigue does not occur in isolation ; rather , it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain , unrefreshing sleep , anxiety , depression , cognitive difficulties , and so on .
Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms .