Michele Thomas, PharmD, BCPP
This session can be purchased in CPNP University
Fibromyalgia is a medical syndrome associated with widespread pain and sleep problems leading to chronic daytime fatigue. The combination of pain and sleep disturbances is a double-edged sword as pain makes sleep more difficult and sleep deprivation exacerbates pain. Christopher Herndon, PharmD, CPE, FASHP shared his expertise at the CPNP 2018 meeting in his presentation titled Painfully Sleepless: Treatment of Sleep Disorders in Fibromyalgia. Dr. Herndon is a professor with the Southern Illinois University Edwardsville (SIUE) School of Pharmacy and treats chronic pain patients at a multidisciplinary family medicine clinic.
Up to 90% of patients with fibromyalgia report problems with sleep1, and sleep disturbances in patients with fibromyalgia are slightly different than sleep disturbances in the general population2. Patients with fibromyalgia tend to have more nighttime awakenings and arousals compared to patients with primary insomnia.
Dr. Herndon described several behavioral treatment modalities for insomnia associated with fibromyalgia. Cognitive behavioral therapy (CBT), sleep hygiene counseling, time in bed reduction, and elimination of daytime napping are examples. Out of these, as described by Dr. Herndon, CBT is associated with the most significant improvement in sleep3. Physical treatment modalities include manual therapy, hydrotherapy, acupuncture, and Tai Chi.
Pharmacotherapy directed at insomnia in the setting of fibromyalgia includes the use of cyclobenzaprine, amitriptyline, gabapentin, pregabalin, and trazodone. Interestingly, the traditional hypnotics such as the benzodiazepines are not well studied for patients with fibromyalgia. Dr. Herndon explained that the selection of the best medication for a patient with sleep disturbances in fibromyalgia is difficult as there are few well controlled studies in this population. Dr. Herndon reviewed the limited data and explained the European guidelines recommend cyclobenzaprine, amitriptyline, and pregabalin as treatments of choice for sleep disturbances in patients with fibromyalgia4.
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