The pathology of fibromyalgia is unknown but appears to involve complex interactions of central neurotransmitters with a relationship to pain perception, mood, and sleep. Few controlled trials of drug therapy have been conducted. The purpose of this review is to present relatively detailed information on the characteristics of tricyclic antidepressants, mainly amitriptyline hydrochloride and doxepin hydrochloride, for use as an integral part of the safe and effective management of fibromyalgia and, to a lesser extent, other chronic pain syndromes. I discuss these data with regard to the pharmacologic characteristics, mechanisms of action, adverse effects, and precautions involved with the use of tricyclic antidepressants.
Additional information is given on drug selection and dosage titration.
The relation between occupational activities and fibromyalgia was examined. Questionnaires were completed by 321 fibromyalgic patients from across the United States and Canada. Questions regarded effects of current and past occupations on their fibromyalgia. Twenty four of the 46 health professionals were registered nurses. Patients with fibromyalgia reported that they did not tolerate prolonged repetitive activities, particularly under high stress or in uncomfortable climatic conditions.