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1

Fibromyalgia syndrome - management according to evidence-based medicine

100%

Kocot-Kępska M., Dobrogowski J.

Ból

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2011

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vol. 12

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issue 3

EN

Fibromialgia is a chronic syndrome with widespread musculoskeletal pain, accompanied by chronic fatigue, depression and sleep disturbances. Pathophysiology is still not fully understood, may include peripheral and central sensitization, failure of descending antinociceptive systems and hypothalamic-pituitary-adrenal axis. Due to unknown etiology, negative impact on quality of life and the high prevalence the treatment should be multimodal and according to experts recommendations and evidence-based medicine pharmacotherapy (antidepressants, antiepileptics), cognitive-behavioral therapy, aerobic exercises and multimodal treatment programs should be implemented.

PL

Fibromialgia jest przewlekłym schorzeniem z uogólnionym bólem mięśniowo-szkieletowym, z towarzyszącymi: zmęczeniem, zaburzeniami snu i nastroju. Patofizjologia nie została do końca wyjaśniona, ale może obejmować obwodową i ośrodkową sensytyzację, upośledzenie zstępujących układów antynocyceptywnych oraz osi podwzgórze-przysadka-nadnercza. Ze względu na niejasną etiologię, znaczny negatywny wpływ na jakość życia pacjentów oraz wysoką zachorowalność leczenie powinno być wielokierunkowe i zgodnie z zaleceniami ekspertów powinno obejmować farmakoterapię (leki przeciwdepresyjne, przeciwdrgawkowe), terapię poznawczobehawioralną, ćwiczenia aerobowe, wielokierunkowe programy terapeutyczne jako metody o udowodnionej skuteczności.

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Terapia naltreksonem w niskiej dawce – skuteczność i bezpieczeństwo terapii stosowanej poza wskazaniami

63%

Stańczak A.

Farmacja Polska

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2020

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vol. 75

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issue 12

676-686

EN

Naltrexone is well-known opioid antagonist used in chronic or acute states of abuse, respectively. Nowadays the low doses of this drug are gaining popularity among researchers, doctors and patients seeking alternatives to well-known and widely used therapies in various indications. The low-dose naltrexone (LDN) is the therapy which involving the use of naltrexone at daily doses 10 times lower or even lower (usually 1 mg - 5 mg) than in the approved by Food and Drug Administration and European Medicines Agency. The therapy is usually prepared by using pure substance (obtained from manufacturer) or by preparing appropriate dosage from drug available on the market. In accordance with available reports low dosage of naltrexone may acts through short-term and intermittent binding to opioid receptors causes a compensatory increase in endogenous opioids including β-endorphins and increase in expression of μ and δ receptors. The LDN also binds briefly the opioid growth factor receptor (OGFr), causing blockage of binding to opioid growth factor (OGF, met-enkephalin). The researchers also believe that low-dose naltrexone is antagonist of TLR4 receptor and acts as glial cells modulator. Based on the mechanism of action of low-doses of naltrexone, which is not fully known, researchers are trying to confirm reports concerning the efficacy and safety of the therapy in many diseases, including autoimmune disorders (including Crohn's disease, multiple sclerosis), fibromyalgia and chronic pain, cancer or dermatological diseases. The safety profile of naltrexone at standard doses (50-100 mg) is well known when the drug is used in accordance with registered indications. The information on the safety of LDN treatment protocol is still limited and the data collected is insufficient. Preliminary reports may suggest that treatment is relatively safe however, to confirm safety profile and effects of chronic use it is necessary to conduct extensive, long-term studies in large, varied populations. Despite the lack of registration in any indication and necessity of conducting extensive research on the safety and effectiveness of its use, this therapy has gained a wide range of supporters among both doctors and patients and has been adopted as an alternative off-label treatment. If the effectiveness and safety of LDN are confirmed, it will be undoubtedly a breakthrough therapy, willingly used by patients around the world due to its low cost, availability, safety profile and easy to use.

PL

Low-dose naltrexone (LDN) – terapia naltreksonem w niskiej dawce polegająca na zastosowaniu naltreksonu w dawkach dobowych 10-cio krotnie niższych lub mniejszych (zwykle 1 mg – 5 mg) niż w zarejestrowanej terapii zyskuje co raz to większą popularność. W oparciu o mechanizm działania niskich dawek naltreksonu badacze starają się potwierdzić doniesienia dotyczące skuteczność i bezpieczeństwo terapii w wielu chorobach, w tym o podłożu autoimmunologicznym (między innymi: chorobie Leśniowskiego-Crohna, stwardnieniu rozsianym), fibromialgii i przewlekłym bólu, nowotworach czy chorobach dermatologicznych. Pomimo braku rejestracji w jakimkolwiek wskazaniu i potrzeby przeprowadzenia rozległych badań dotyczących bezpieczeństwa oraz skuteczności jej stosowania, terapia ta zyskała szerokie grono zwolenników zarówno wśród lekarzy jak i pacjentów i została przyjęta jako alternatywna metoda leczenia off-label.

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Niefarmokologiczne metody leczenia fibromialgii / Non-pharmacological treatment of fibromyalgia

51%

Szczuka E., Gruszecka-Marczyńska K.

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2011

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vol. 19

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issue 2

47-58

EN

Fibromyalgia is estimated to affect almost 3% of the population. In developed countries this particular disorder is assumed to be growing social problem. Psychosomatic and chronic character of fibromyalgia creates many problems for patients suffering of it in normal social activity and decreases the quality of their life. The symptomatic treatment is oriented on the pharmacological methods mainly. Non-pharmacological treatment seems to be new therapeutic and research problem. In this work the actual knowledge in subject of the physical activity, biological renewal, physiotherapy as well as methods of the relaxing and education therapy was presented in aspect of the fibromyalgia treatment

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1 Stańczak A.

1 Szczuka E.

Fibromyalgia syndrome - management according to evidence-based medicine

Terapia naltreksonem w niskiej dawce – skuteczność i bezpieczeństwo terapii stosowanej poza wskazaniami

Niefarmokologiczne metody leczenia fibromialgii / Non-pharmacological treatment of fibromyalgia