Modafinil in
fibromyalgia treatment.
Schaller JL, Behar D.
County Research Center, West
Chester, PA and
Eastern Pennsylvania Psychiatric Institute, Philadelphia, PA
J Neuropsychiatry Clin Neurosci 2001 Fall;13(4):530-1
ABSTRACT
Modafinil has shown benefits in fatigue-related
disorders such as multiple sclerosis and various forms of neurological
fatigue.1,2
We report the successful use of modafinil for fibromyalgia (FM)
fatigue in 4 patients in an open study with naturalistic on-off experiences. A
rheumatologist and another physician confirmed each diagnosis of FM.
FM affects 2% of the population and is
characterized by chronic musculoskeletal pain (especially at characteristic
soft-tissue trigger sites); severe fatigue, typically lasting >24 h with
minimal activity; nonrestorative sleep; and mood abnormalities.3–5 The
American College of Rheumatology adds the criterion of widespread pain for 3
months with tenderness in at least 11 of 18 specific trigger-point sites. 6
We excluded 2 patients for comorbid secondary
major depression (MD) until they went into full remission on their
antidepressants, confirmed by two MD research scales, to remove the variable
of modafinil antidepressant augmentation.
7,8
All patients had physical exams and laboratory
testing excluding Lyme disease, Ehrlichia equi and E. chaffeensis, Babesia
microti, rheumatoid or spinal arthritis, major sleep disorders, and abnormal
cervical and brain MRIs.
After an average 18 months of medical care,
they found minimal relief. None could stay awake 16 hours on 3 consecutive
days, shop routinely, provide basic childcare, drive over an hour per day,
balance a checkbook, maintain a 30-hour work week, or cook routinely. Patient
expectations for relief from this trial were very low because of past
failures.
Two FM patients reported some beneficial
effects of depression on day one at 100 mg q A.M., which were nevertheless
incomplete. Weekly dose adjustments upward in 50-mg increments and the
addition of an afternoon dose met with reports of highly significant benefit
by all patients. After titration adjustments were finalized over 3 weeks, all
reported a sustained increase in functional capacity. Global Assessment of
Functioning average improvement was a change from 55 to 70; that is, from
moderate impairment to minimal impairment.
All patients had a strong desire to continue
their treatment because they now reported being "functional," able
to work or to care for their children. Fatigue improved; all patients reported
highly significant improvement in alertness and a reduced need for disruptive
naps. They received unsolicited comments about their improvement from their
children, spouses, employers, or parents, who were unaware of the modafinil
trial. Benefits persisted over 3 continuous months at the same dose.
Alertness benefits were lost if a breakfast modafinil
dose was skipped. Benefits returned quickly the following day if modafinil
was restarted. Each patient missed at least 2 days of medication
because of forgotten doses or a lost prescription. They reported a full return
of fatigue and impairment that day. These mishaps represent naturalistic
"on-off" experiments, supporting the immediate efficacy of modafinil.
This immediate effect contrasts with our clinical expectations of gradual
benefits.
The mean dose was 250 mg per day with a range
of 150 to 300 mg. Patients took a dose of 150–200 mg in the morning, and
half of them took an extra 50 mg or 100 mg in the early afternoon. One patient
reported slight anxiety during week one, which resolved with a 50-mg dose
reduction. We experienced inconclusive results in 3 patients, not included in
our report, who dropped out or were lost to follow-up for reasons such as
relocation.
The fatigue of FM causes marked impairment and
has no definitive single treatment. Modafinil is a potential treatment option
worthy of larger clinical trials.
-
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2001, New Orleans, LA. Abstract NR532:144.
1. modafinil is
a potential treatment for fibromyalgia
2. modafinil improves
fatigue in patients with multiple sclerosis
3. modafinil offers
promise as an augmentation to antidepressants
4. modafinil excessive
sleepiness in Parkinson's disease
5. modafinil excessive
daytime sleepiness in Parkinson's disease
6. modafinil may
be useful for attention-deficit/hyperactivity disorder
7. modafinil benefits
cerebral palsy in an unknown way
8. modafinil
article
9. modafinil
amplification of cortical serotonin release
10. modafinil
treatment of alcoholic organic brain syndrome
11. modafinil
effect on melatonin, cortisol, and growth hormone
12. modafinil
in obstructive sleep apnea-hypopnea syndrome
13. modafinil
vs dextroamphetamine in treatment of adult ADHD
14. modafinil
efficacy in narcolepsy
15. modafinil
switching from narcolepsy drugs to modafinil
16. modafinil
drug of choice for narcolepsy
17. modafinil
dopaminergic transmission mediates CNS stimulants
18. modafinil
for daytime sleepiness in sleep apnea
19. modafinil
treatment of residual excessive daytime sleepiness
20. modafinil
in the treatment of narcolepsy
21. modafinil
and naps as counter measures in sleep
deprivation
22. modafinil
effect on narcolepsy
23. modafinil
as a treatment for excessive daytime sleepiness
24. modafinil
a narcolepsy study
25. modafinil
use in a sleep deprivation experiment
26. modafinil for
sustaining the alertness of helicopter pilots
27. modafinil the
unique properties of a new stimulant
28. modafinil dosage
and safety
29. modafinil in
treatment of fatigue in multiple sclerosis
30. modafinil non-addictive
potential of modafinil
31. modafinil successful
treatment of hypersomnia & narcolepsy
32. modafinil physiological
effects of modafinil in drug abusers
33. modafinil narcolepsy:
symptoms and management
34. modafinil cognitive
enhancing effects of modafinil
