Daniel J. Clauw, MD

clinical pearls for the treatment of patients with fibromyalgia and future developments in the pipeline for disease management

Clinical Pearls for the Management of Fibromyalgia

This is a video synopsis of a discussion involving Daniel J. Clauw, MD, a professor of anesthesiology, medicine/rheumatology, and psychiatry at the University of Michigan. Dr. Clauw shares clinical insights on managing fibromyalgia, emphasizing non-pharmacologic approaches.

Sleep is identified as crucial, and Dr. Clauw recommends employing cognitive-behavioral therapy for insomnia to enhance sleep quality. He advocates for promoting activity but refrains from using the term "exercise," suggesting the focus should be on increasing overall activity levels rather than reaching an aerobic threshold. Non-pharmacologic therapies play a vital role, with Dr. Clauw encouraging the integration of practices such as yoga, acupuncture, acupressure, Tai Chi, mindfulness meditation, and myofascial release therapy, which have gained evidence-based support.

Acknowledging the evolving understanding of fibromyalgia subsets, Dr. Clauw emphasizes personalized treatment. Some individuals may benefit from cognitive-behavioral therapy tailored to address psychological factors, while others may require interventions targeting sleep or activity levels. Notably, ongoing research explores the potential benefits of psychedelics, with a trial at the University of Michigan investigating psilocybin in fibromyalgia.

Looking forward, Dr. Clauw anticipates advancements in neural stimulators and electrical stimulators, such as vagal nerve stimulators, to expand therapeutic options. He underscores the importance of recognizing individual variations among fibromyalgia patients and tailoring treatments accordingly, moving away from a one-size-fits-all approach.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.

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Dr Daniel J. Clauw shares clinical pearls for the treatment of patients with fibromyalgia and comments on future developments in the pipeline for disease management.

selecting FDA approved therapeutic agents for fibromyalgia treatment and clinical treatment strategy when first-line pharmacological therapy fails

Treatment Selection and Strategy for Fibromyalgia Agents

This is a video synopsis of a discussion involving Daniel J. Clauw, MD, a professor of anesthesiology, medicine/rheumatology, and psychiatry at the University of Michigan. Dr. Clauw addresses the pharmacologic treatment approach for fibromyalgia, focusing on the three classes of drugs: tricyclics, gabapentinoids, and serotonin-norepinephrine reuptake inhibitors (SNRIs).

He suggests tailoring drug selection based on predominant symptoms. For individuals with sleep issues, initiating treatment with a tricyclic drug or a gabapentinoid at a low dose at bedtime is recommended. Alternatively, if symptoms lean toward depression, fatigue, or memory problems, starting with an SNRI, such as duloxetine or milnacipran, may be more beneficial. Dr. Clauw highlights the difference between the two SNRIs, with milnacipran being more noradrenergic, potentially aiding fatigue and memory problems.

However, he emphasizes the importance of starting with low doses and adjusting gradually to minimize side effects. If the first-line pharmacologic therapy proves ineffective, Dr. Clauw advocates exploring the other two classes to determine their efficacy. While data supports matching drug classes to specific symptom profiles, he acknowledges that individual responses may vary, encouraging a flexible and personalized approach to fibromyalgia pharmacotherapy.

Daniel J. Clauw, MD, shares his approach to selecting FDA approved therapeutic agents for fibromyalgia treatment and his clinical treatment strategy when first-line pharmacological therapy fails.

current FDA-approved therapies available for the treatment of fibromyalgia and outlines topline safety and efficacy data of these approved agents

Current Treatment Options for Fibromyalgia

This is a video synopsis of a discussion involving Daniel J. Clauw, MD, a professor of anesthesiology, medicine/rheumatology, and psychiatry at the University of Michigan. Dr. Clauw outlines the pharmacologic options for fibromyalgia, highlighting the three drugs approved by the Food and Drug Administration (FDA) in the United States: duloxetine, pregabalin (gabapentinoid), and milnacipran (norepinephrine, serotonin reuptake inhibitor).

Pregabalin, a gabapentinoid, likely works by reducing the release of excitatory neurotransmitters in the brain, thereby dampening the volume control on pain. Dr. Clauw emphasizes the importance of using gabapentinoids at bedtime to improve sleep depth, crucial for individuals with fibromyalgia. Duloxetine and milnacipran, both serotonin-norepinephrine reuptake inhibitors, differ in their noradrenergic effects, with milnacipran being more noradrenergic. Norepinephrine is deemed crucial for pain reduction and fatigue improvement.

While all three drugs demonstrate efficacy in approximately one out of three to four individuals, their overall effectiveness is as good as it gets in the pain management field. Dr. Clauw acknowledges that real-life experience over the past decade aligns with the data from original trials, indicating that only a subset of individuals continues on these therapies for the long term. The discussion underscores the current state of fibromyalgia pharmacotherapy and the ongoing challenges in achieving optimal outcomes for individuals with fibromyalgia.

an overview of pharmacologic and nonpharmacologic therapeutic approaches for the management of fibromyalgia and challenges and unmet needs for patients

Approaching Management of Fibromyalgia and Unmet Needs in Treatment

This is a video synopsis of a discussion involving Daniel J. Clauw, MD, a professor of anesthesiology, medicine/rheumatology, and psychiatry at the University of Michigan. Dr. Clauw discusses the treatment approaches for fibromyalgia, emphasizing the increasing understanding that non-drug therapies are likely preferable in conjunction with pharmaceutical interventions.

He identifies three general categories of drugs that may be helpful for fibromyalgia: tricyclic drugs, serotonin-norepinephrine reuptake inhibitors (SNRIs), and gabapentinoids. Dr. Clauw introduces the concept of drugs as a "chemical nudge," helping individuals with fibromyalgia manage symptoms such as fatigue, pain, and sleep disturbances, enabling them to engage in non-drug therapies effectively. Non-pharmacologic strategies, including improving sleep, increasing activity levels, and stress reduction, play a significant role in managing fibromyalgia and nociplastic pain.

Dr. Clauw acknowledges the challenges in fibromyalgia care, including delayed identification and treatment initiation. He stresses the importance of early identification and aggressive treatment to prevent the accumulation of psychosocial factors that exacerbate pain and complicate treatment. Despite progress, there is still a need to overcome physician misunderstandings and reduce the stigma associated with fibromyalgia, advocating for a comprehensive approach to improve the lives of individuals with fibromyalgia-like pain.

Dr Daniel J. Clauw provides an overview of pharmacologic and nonpharmacologic therapeutic approaches for the management of fibromyalgia and comments on challenges and unmet needs for patients.

Daniel J. Clauw, MD

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