Current Pain and Headache Reports

, Volume 15, Issue 5, pp 347–357 | Cite as

Sleep Disorders and Fibromyalgia

  • Suely RoizenblattEmail author
  • Nilton Salles Rosa Neto
  • Sergio Tufik


Disordered sleep is such a prominent symptom in fibromyalgia that the American College of Rheumatology included symptoms such as waking unrefreshed, fatigue, tiredness, and insomnia in the 2010 diagnostic criteria for fibromyalgia. Even though sleep recording is not part of the routine evaluation, polysomnography may disclose primary sleep disorders in patients with fibromyalgia, including obstructive sleep apnea and restless leg syndrome. In addition, genetic background and environmental susceptibility link fibromyalgia and further sleep disorders. Among nonpharmacological treatment proposed for sleep disturbance in fibromyalgia, positive results have been obtained with sleep hygiene and cognitive-behavioral therapy. The effect of exercise is contradictory, but overweight or obese patients with fibromyalgia should be encouraged to lose weight. Regarding the approved antidepressants, amitriptyline proved to be superior to duloxetine and milnacipran for sleep disturbances. New perspectives remain on the narcolepsy drug sodium oxybate, which recently was approved for sleep management in fibromyalgia.


Sleep Fibromyalgia pathophysiology Treatment Sleep disorders Fibromyalgia Fibromyalgia criteria Amitriptyline Cognitive-behavioral therapy Pain Nonrestorative sleep Genetics Polysomnography Inventory Sleep quality Medical Outcomes Study Sleep Scale Fibromyalgia Impact Questionnaire Sleep Assessment Questionnaire Patient-Reported Outcome Measurement Information System 



No potential conflicts of interest relevant to this article were reported.


Papers of particular interests, published recently, have been highlighted as Of importance •• Of major importance

  1. 1.
    Yunus MB, Ahles TA, Aldag JC, Masi AT. Relationship of clinical features with psychological status in primary fibromyalgia. Arthritis Rheum. 1991;34:15–21.PubMedCrossRefGoogle Scholar
  2. 2.
    Kop WJ, Lyden A, Berlin AA, Ambrose K, Olsen C, Gracely RH, et al. Ambulatory monitoring of physical activity and symptoms in fibromyalgia and chronic fatigue syndrome. Arthritis Rheum. 2005;52:296–303.PubMedCrossRefGoogle Scholar
  3. 3.
    • Davies KA, Macfarlane GJ, Nicholl BI, Dickens C, Morriss R, Ray D, et al. Restorative sleep predicts the resolution of chronic widespread pain: results from the EPIFUND study. Rheumatology (Oxford). 2008;47:1809–13. This study evidences the effect of restorative sleep on musculoskeletal health in patients with fibromyalgia.CrossRefGoogle Scholar
  4. 4.
    Gupta A, Silman AJ, Ray D, Morriss R, Dickens C, MacFarlane GJ, et al. The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study. Rheumatology (Oxford). 2007;46:666–71.CrossRefGoogle Scholar
  5. 5.
    Affleck G, Urrows S, Tennen H, Higgins P, Abeles M. Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia. Pain. 1996;68:363–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160–72.PubMedCrossRefGoogle Scholar
  7. 7.
    White KP, Speechley M, Harth M, Ostbye T. The London Fibromyalgia Epidemiology Study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls. J Rheumatol. 1999;26:1577–85.PubMedGoogle Scholar
  8. 8.
    Theadom A, Cropley M, Humphrey KL. Exploring the role of sleep and coping in quality of life in fibromyalgia. J Psychosom Res. 2007;62:145–51.PubMedCrossRefGoogle Scholar
  9. 9.
    Bigatti SM, Hernandez AM, Cronan TA, Rand KL. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. 2008;59:961–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Wolfe F, Anderson J, Harkness D, Bennett RM, Caro XJ, Goldenberg DL, et al. Health status and disease severity in fibromyalgia: results of a six-center longitudinal study. Arthritis Rheum. 1997;40:1571–9.PubMedCrossRefGoogle Scholar
  11. 11.
    MacFarlane GJ, Thomas E, Papageorgiou AC, Schollum J, Croft PR, Silman AJ. The natural history of chronic pain in the community: a better prognosis than in the clinic? J Rheumatol. 1996;23:1617–20.PubMedGoogle Scholar
  12. 12.
    Nicassio PM, Moxham EG, Schuman CE, Gevirtz RN. The contribution of pain, reported sleep quality, and depressive symptoms to fatigue in fibromyalgia. Pain. 2002;100:271–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Moldofsky H. Management of sleep disorders in fibromyalgia. Rheum Dis Clin North Am. 2002;28:353–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Agargun MY, Tekeoglu I, Gunes A, Adak B, Kara H, Ercan M. Sleep quality and pain threshold in patients with fibromyalgia. Compr Psychiatry. 1999;40:226–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Hamilton NA, Catley D, Karlson C. Sleep and the affective response to stress and pain. Health Psychol. 2007;26:288–95.PubMedCrossRefGoogle Scholar
  16. 16.
    Lorton D, Lubahn CL, Estus C, Millar BA, Carter JL, Wood CA, et al. Bidirectional communication between the brain and the immune system: implications for physiological sleep and disorders with disrupted sleep. Neuroimmunomodulation. 2006;13:357–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Loevinger BL, Muller D, Alonso C, Coe CL. Metabolic syndrome in women with chronic pain. Metabolism. 2007;56:87–93.PubMedCrossRefGoogle Scholar
  18. 18.
    Chervin RD, Teodorescu M, Kushwaha R, Deline AM, Brucksch CB, Ribbens-Grimm C, et al. Objective measures of disordered sleep in fibromyalgia. J Rheumatol. 2009;36:2009–16.PubMedCrossRefGoogle Scholar
  19. 19.
    Adler GK, Manfredsdottir VF, Creskoff KW. Neuroendocrine abnormalities in fibromyalgia. Curr Pain Headache Rep. 2002;6:289–98.PubMedCrossRefGoogle Scholar
  20. 20.
    Torpy DJ, Papanicolaou DA, Lotsikas AJ, Wilder RL, Chrousos GP, Pillemer SR. Responses of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis to interleukin-6: a pilot study in fibromyalgia. Arthritis Rheum. 2000;43:872–80.PubMedCrossRefGoogle Scholar
  21. 21.
    Calis M, Gokce C, Ates F, Ulker S, Izgi HB, Demir H, et al. Investigation of the hypothalamo-pituitary-adrenal axis (HPA) by 1 microg ACTH test and metyrapone test in patients with primary fibromyalgia syndrome. J Endocrinol Investig. 2004;27:42–6.Google Scholar
  22. 22.
    Martinez-Lavin M, Hermosillo AG. Autonomic nervous system dysfunction may explain the multisystem features of fibromyalgia. Semin Arthritis Rheum. 2000;29:197–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Abeles AM, Pillinger MH, Solitar BM, Abeles M. Narrative review: the pathophysiology of fibromyalgia. Ann Intern Med. 2007;146:726–34.PubMedGoogle Scholar
  24. 24.
    Rains JC, Penzien DB. Sleep and chronic pain: challenges to the alpha-EEG sleep pattern as a pain specific sleep anomaly. J Psychosom Res. 2003;54:77–83.PubMedCrossRefGoogle Scholar
  25. 25.
    Scharf MB, Baumann M, Berkowitz DV. The effects of sodium oxybate on clinical symptoms and sleep patterns in patients with fibromyalgia. J Rheumatol. 2003;30:1070–4.PubMedGoogle Scholar
  26. 26.
    McCracken LM, Iverson GL. Disrupted sleep patterns and daily functioning in patients with chronic pain. Pain Res Manag. 2002;7:75–9.PubMedGoogle Scholar
  27. 27.
    Roizenblatt S, Tufik S, Goldenberg J, Pinto LR, Hilario MO, Feldman D. Juvenile fibromyalgia: clinical and polysomnographic aspects. J Rheumatol. 1997;24:579–85.PubMedGoogle Scholar
  28. 28.
    Bodenmann S, Rusterholz T, Durr R, Stoll C, Bachmann V, Geissler E, et al. The functional Val158Met polymorphism of COMT predicts interindividual differences in brain alpha oscillations in young men. J Neurosci. 2009;29:10855–62.PubMedCrossRefGoogle Scholar
  29. 29.
    Mease P, Arnold LM, Bennett R, Boonen A, Buskila D, Carville S, et al. Fibromyalgia syndrome. J Rheumatol. 2007;34:1415–25.PubMedGoogle Scholar
  30. 30.
    •• Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62:600–10. This study brings a new proposal of simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender-point examination.CrossRefGoogle Scholar
  31. 31.
    Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L. An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord. 2007;8:27.PubMedCrossRefGoogle Scholar
  32. 32.
    Cappelleri JC, Bushmakin AG, McDermott AM, Dukes E, Sadosky A, Petrie CD, et al. Measurement properties of the Medical Outcomes Study Sleep Scale in patients with fibromyalgia. Sleep Med. 2009;10:766–70.PubMedCrossRefGoogle Scholar
  33. 33.
    Ohayon MM, Roth T. What are the contributing factors for insomnia in the general population? J Psychosom Res. 2001;51:745–55.PubMedCrossRefGoogle Scholar
  34. 34.
    Vernon MK, Dugar A, Revicki D, Treglia M, Buysse D. Measurement of non-restorative sleep in insomnia: a review of the literature. Sleep Med Rev. 2009;14:205–12.PubMedCrossRefGoogle Scholar
  35. 35.
    Martinez D, Cassol CM. Fibromyalgia and sleep-disordered breathing: the missing link. Arthritis Res Ther. 2008;10:408; author reply 409.PubMedCrossRefGoogle Scholar
  36. 36.
    Viola-Saltzman M, Watson NF, Bogart A, Goldberg J, Buchwald D. High prevalence of restless legs syndrome among patients with fibromyalgia: a controlled cross-sectional study. J Clin Sleep Med. 2010;6:423–7.PubMedGoogle Scholar
  37. 37.
    Spitzer AR, Broadman M. A retrospective review of the sleep characteristics in patients with chronic fatigue syndrome and fibromyalgia. Pain Pract. 2010;10:294–300.PubMedCrossRefGoogle Scholar
  38. 38.
    Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995;38:19–28.PubMedCrossRefGoogle Scholar
  39. 39.
    Wolfe F, Hawley DJ. Psychosocial factors and the fibromyalgia syndrome. Z Rheumatol. 1998;57 Suppl 2:88–91.PubMedCrossRefGoogle Scholar
  40. 40.
    Okifuji A, Bradshaw DH, Olson C. Evaluating obesity in fibromyalgia: neuroendocrine biomarkers, symptoms, and functions. Clin Rheumatol. 2009;28:475–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Berger A, Dukes E, Martin S, Edelsberg J, Oster G. Characteristics and healthcare costs of patients with fibromyalgia syndrome. Int J Clin Pract. 2007;61:1498–508.PubMedCrossRefGoogle Scholar
  42. 42.
    May KP, West SG, Baker MR, Everett DW. Sleep apnea in male patients with the fibromyalgia syndrome. Am J Med. 1993;94:505–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Gold AR, Dipalo F, Gold MS, Broderick J. Inspiratory airflow dynamics during sleep in women with fibromyalgia. Sleep. 2004;27:459–66.PubMedGoogle Scholar
  44. 44.
    Pellegrino MJ, Waylonis GW, Sommer A. Familial occurrence of primary fibromyalgia. Arch Phys Med Rehabil. 1989;70:61–3.PubMedGoogle Scholar
  45. 45.
    Buskila D, Neumann L, Hazanov I, Carmi R. Familial aggregation in the fibromyalgia syndrome. Semin Arthritis Rheum. 1996;26:605–11.PubMedCrossRefGoogle Scholar
  46. 46.
    Hudson JI, Arnold LM, Keck Jr PE, Auchenbach MB, Pope Jr HG. Family study of fibromyalgia and affective spectrum disorder. Biol Psychiatry. 2004;56:884–91.PubMedCrossRefGoogle Scholar
  47. 47.
    Bennett RM, Clark SR, Campbell SM, Burckhardt CS. Low levels of somatomedin C in patients with the fibromyalgia syndrome. A possible link between sleep and muscle pain. Arthritis Rheum. 1992;35:1113–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Bradley LA. Pathophysiology of fibromyalgia. Am J Med. 2009;122:S22–30.PubMedCrossRefGoogle Scholar
  49. 49.
    Lallukka T, Rahkonen O, Lahelma E, Arber S. Sleep complaints in middle-aged women and men: the contribution of working conditions and work-family conflicts. J Sleep Res. 2010;19:466–77.PubMedCrossRefGoogle Scholar
  50. 50.
    • Barclay NL, Eley TC, Buysse DJ, Rijsdijk FV, Gregory AM. Genetic and environmental influences on different components of the Pittsburgh Sleep Quality Index and their overlap. Sleep. 2010;33:659–68. This is an important study describing genetic and nonshared environmental factors that explain individual differences with regards to different components of sleep quality and duration.PubMedGoogle Scholar
  51. 51.
    Bondy B, Spaeth M, Offenbaecher M, Glatzeder K, Stratz T, Schwarz M, et al. The T102C polymorphism of the 5-HT2A-receptor gene in fibromyalgia. Neurobiol Dis. 1999;6:433–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Gursoy S, Erdal E, Herken H, Madenci E, Alasehirli B. Association of T102C polymorphism of the 5-HT2A receptor gene with psychiatric status in fibromyalgia syndrome. Rheumatol Int. 2001;21:58–61.PubMedCrossRefGoogle Scholar
  53. 53.
    Larkin EK, Patel SR, Goodloe RJ, Li Y, Zhu X, Gray-McGuire C, et al. A candidate gene study of obstructive sleep apnea in European Americans and African Americans. Am J Respir Crit Care Med. 2010;182:947–53.PubMedCrossRefGoogle Scholar
  54. 54.
    Offenbaecher M, Bondy B, de Jonge S, Glatzeder K, Kruger M, Schoeps P, et al. Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region. Arthritis Rheum. 1999;42:2482–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Gursoy S. Absence of association of the serotonin transporter gene polymorphism with the mentally healthy subset of fibromyalgia patients. Clin Rheumatol. 2002;21:194–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Deuschle M, Schredl M, Schilling C, Wust S, Frank J, Witt SH, et al. Association between a serotonin transporter length polymorphism and primary insomnia. Sleep. 2010;33:343–7.PubMedGoogle Scholar
  57. 57.
    Buskila D, Cohen H, Neumann L, Ebstein RP. An association between fibromyalgia and the dopamine D4 receptor exon III repeat polymorphism and relationship to novelty seeking personality traits. Mol Psychiatry. 2004;9:730–1.PubMedCrossRefGoogle Scholar
  58. 58.
    Paus S, Seeger G, Brecht HM, Koster J, El-Faddagh M, Nothen MM, et al. Association study of dopamine D2, D3, D4 receptor and serotonin transporter gene polymorphisms with sleep attacks in Parkinson’s disease. Mov Disord. 2004;19:705–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Zubieta JK, Heitzeg MM, Smith YR, Bueller JA, Xu K, Xu Y, et al. COMT val158met genotype affects mu-opioid neurotransmitter responses to a pain stressor. Science. 2003;299:1240–3.PubMedCrossRefGoogle Scholar
  60. 60.
    Gursoy S, Erdal E, Herken H, Madenci E, Alasehirli B, Erdal N. Significance of catechol-O-methyltransferase gene polymorphism in fibromyalgia syndrome. Rheumatol Int. 2003;23:104–7.PubMedGoogle Scholar
  61. 61.
    Riemann D, Voderholzer U, Berger M. Non-restorative sleep and insomnia. Diagnostic and therapeutic options for psychiatry and psychotherapy. Nervenarzt. 2003;74:450–67. quiz 468–459.PubMedCrossRefGoogle Scholar
  62. 62.
    Rizzi M, Sarzi-Puttini P, Atzeni F, Capsoni F, Andreoli A, Pecis M, et al. Cyclic alternating pattern: a new marker of sleep alteration in patients with fibromyalgia? J Rheumatol. 2004;31:1193–9.PubMedGoogle Scholar
  63. 63.
    Landis CA, Lentz MJ, Rothermel J, Buchwald D, Shaver JL. Decreased sleep spindles and spindle activity in midlife women with fibromyalgia and pain. Sleep. 2004;27:741–50.PubMedGoogle Scholar
  64. 64.
    Lentz MJ, Landis CA, Rothermel J, Shaver JL. Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women. J Rheumatol. 1999;26:1586–92.PubMedGoogle Scholar
  65. 65.
    Roizenblatt S, Moldofsky H, Benedito-Silva AA, Tufik S. Alpha sleep characteristics in fibromyalgia. Arthritis Rheum. 2001;44:222–30.PubMedCrossRefGoogle Scholar
  66. 66.
    Korszun A, Young EA, Engleberg NC, Brucksch CB, Greden JF, Crofford LA. Use of actigraphy for monitoring sleep and activity levels in patients with fibromyalgia and depression. J Psychosom Res. 2002;52:439–43.PubMedCrossRefGoogle Scholar
  67. 67.
    Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol. 2005;23:S154–62.PubMedGoogle Scholar
  68. 68.
    Cesta A, Moldofsky H, Sammut C. The sensitivity and specificity of the Sleep Assessment Questionnaire (SAQ) as a measure of non-restorative sleep. Sleep. 1999;22:14.Google Scholar
  69. 69.
  70. 70.
    Hays R, Stewart A. Sleep measures. In: Stewart A, Ware J, editors. Measuring functioning and well-being: the medical outcomes study approach. Duke University Press; 1992, p. 235–59.Google Scholar
  71. 71.
    Mease PJ, Russell IJ, Arnold LM, Florian H, Young Jr JP, Martin SA, et al. A randomized, double-blind, placebo-controlled, phase III trial of pregabalin in the treatment of patients with fibromyalgia. J Rheumatol. 2008;35:502–14.PubMedGoogle Scholar
  72. 72.
    Jenkins CD, Stanton BA, Niemcryk SJ, Rose RM. A scale for the estimation of sleep problems in clinical research. J Clin Epidemiol. 1988;41:313–21.PubMedCrossRefGoogle Scholar
  73. 73.
    • Crawford BK, Piault EC, Lai C, Sarzi-Puttini P. Assessing sleep in fibromyalgia: investigation of an alternative scoring method for the Jenkins Sleep Scale based on data from randomized controlled studies. Clin Exp Rheumatol. 2011;28:S100–9. This study evidences the validity of the Jenkins Sleep Scale.Google Scholar
  74. 74.
    •• Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskila D, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008;67:536–41. This is an important reference on the nine recommendations for the management of fibromyalgia syndrome developed using a systematic review and expert consensus.PubMedCrossRefGoogle Scholar
  75. 75.
    Culpepper L. Nonpharmacologic care of patients with fibromyalgia. J Clin Psychiatry. 2010;71:e20.PubMedCrossRefGoogle Scholar
  76. 76.
    Edinger JD, Wohlgemuth WK, Krystal AD, Rice JR. Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial. Arch Intern Med. 2005;165:2527–35.PubMedCrossRefGoogle Scholar
  77. 77.
    Miro E, Lupianez J, Martinez MP, Sanchez AI, Diaz-Piedra C, Guzman MA, et al. Cognitive-behavioral therapy for insomnia improves attentional function in fibromyalgia syndrome: a pilot, randomized controlled trial. J Health Psychol. 2011. doi:  10.1177/1359105310390544 at
  78. 78.
    Munguia-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89:2250–7.PubMedCrossRefGoogle Scholar
  79. 79.
    Hauser W, Klose P, Langhorst J, Moradi B, Steinbach M, Schiltenwolf M, et al. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis Res Ther. 2010;12:R79.PubMedCrossRefGoogle Scholar
  80. 80.
    Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010;363:743–54.PubMedCrossRefGoogle Scholar
  81. 81.
    van Koulil S, Effting M, Kraaimaat FW, van Lankveld W, van Helmond T, Cats H, et al. Cognitive-behavioural therapies and exercise programmes for patients with fibromyalgia: state of the art and future directions. Ann Rheum Dis. 2007;66:571–81.PubMedCrossRefGoogle Scholar
  82. 82.
    Langhorst J, Klose P, Musial F, Irnich D, Hauser W. Efficacy of acupuncture in fibromyalgia syndrome–a systematic review with a meta-analysis of controlled clinical trials. Rheumatology (Oxford). 2010;49:778–88.CrossRefGoogle Scholar
  83. 83.
    Saddichha S. Diagnosis and treatment of chronic insomnia. Ann Indian Acad Neurol. 2010;13:94–102.PubMedCrossRefGoogle Scholar
  84. 84.
    Qureshi A, Lee-Chiong Jr T. Medications and their effects on sleep. Med Clin North Am. 2004;88:751–66, x.PubMedCrossRefGoogle Scholar
  85. 85.
    • Hauser W, Petzke F, Uceyler N, Sommer C. Comparative efficacy and acceptability of amitriptyline, duloxetine and milnacipran in fibromyalgia syndrome: a systematic review with meta-analysis. Rheumatology (Oxford). 2011;50:532–43. This article is a good review on the efficacy and acceptability of antidepressants recommended for the treatment of fibromyalgia.CrossRefGoogle Scholar
  86. 86.
    Hindmarch I, Dawson J, Stanley N. A double-blind study in healthy volunteers to assess the effects on sleep of pregabalin compared with alprazolam and placebo. Sleep. 2005;28:187–93.PubMedGoogle Scholar
  87. 87.
    Holman AJ, Myers RR. A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Arthritis Rheum. 2005;52:2495–505.PubMedCrossRefGoogle Scholar
  88. 88.
    Distler O, Eich W, Dokoupilova E, Dvorak Z, Fleck M, Gaubitz M, et al. Evaluation of the efficacy and safety of terguride in patients with fibromyalgia syndrome: results of a twelve-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum. 2010;62:291–300.PubMedCrossRefGoogle Scholar
  89. 89.
    Arnold LM, Russell IJ, Diri EW, Duan WR, Young Jr JP, Sharma U, et al. A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia. J Pain. 2008;9:792–805.PubMedCrossRefGoogle Scholar
  90. 90.
    Crofford LJ, Rowbotham MC, Mease PJ, Russell IJ, Dworkin RH, Corbin AE, et al. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2005;52:1264–73.PubMedCrossRefGoogle Scholar
  91. 91.
    •• Moldofsky H, Inhaber NH, Guinta DR, Alvarez-Horine SB. Effects of sodium oxybate on sleep physiology and sleep/wake-related symptoms in patients with fibromyalgia syndrome: a double-blind, randomized, placebo-controlled study. J Rheumatol. 2010;37:2156–66. This is a large cohort study that reveals the efficacy of sodium oxybate in reducing wakefulness after sleep onset and increasing non-REM sleep of patients with fibromyalgia.PubMedCrossRefGoogle Scholar
  92. 92.
    Russell IJ, Holman AJ, Swick TJ, Alvarez-Horine S, Wang YG, Guinta D; for the Sodium Oxybate 06-008 FM Study Group. Sodium oxybate reduces pain, fatigue, and sleep disturbance and improves functionality in fibromyalgia: results from a 14-week, randomized, double-blind, placebo-controlled study. Pain. 2011;152:1007–17.Google Scholar
  93. 93.
    Bennett RM, Schein J, Kosinski MR, Hewitt DJ, Jordan DM, Rosenthal NR. Impact of fibromyalgia pain on health-related quality of life before and after treatment with tramadol/acetaminophen. Arthritis Rheum. 2005;53:519–27.PubMedCrossRefGoogle Scholar
  94. 94.
    Roehrs TA. Does effective management of sleep disorders improve pain symptoms? Drugs. 2009;69 Suppl 2:5–11.PubMedCrossRefGoogle Scholar
  95. 95.
    Citera G, Arias MA, Maldonado-Cocco JA, Lazaro MA, Rosemffet MG, Brusco LI, et al. The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol. 2000;19:9–13.PubMedCrossRefGoogle Scholar
  96. 96.
    Reiter RJ, Acuna-Castroviejo D, Tan DX. Melatonin therapy in fibromyalgia. Curr Pain Headache Rep. 2007;11:339–42.PubMedCrossRefGoogle Scholar
  97. 97.
    Ortiz GG, Crespo-Lopez ME, Moran-Moguel C, Garcia JJ, Reiter RJ, Acuna-Castroviejo D. Protective role of melatonin against MPTP-induced mouse brain cell DNA fragmentation and apoptosis in vivo. Neuro Endocrinol Lett. 2001;22:101–8.PubMedGoogle Scholar
  98. 98.
    Khaldy H, Leon J, Escames G, Bikjdaouene L, Garcia JJ, Acuna-Castroviejo D. Circadian rhythms of dopamine and dihydroxyphenyl acetic acid in the mouse striatum: effects of pinealectomy and of melatonin treatment. Neuroendocrinology. 2002;75:201–8.PubMedCrossRefGoogle Scholar
  99. 99.
    Mayo JC, Sainz RM, Tan DX, Hardeland R, Leon J, Rodriguez C, et al. Anti-inflammatory actions of melatonin and its metabolites, N1-acetyl-N2-formyl-5-methoxykynuramine (AFMK) and N1-acetyl-5-methoxykynuramine (AMK), in macrophages. J Neuroimmunol. 2005;165:139–49.PubMedCrossRefGoogle Scholar
  100. 100.
    Clauw DJ. Commentary on the EULAR recommendations for the management of fibromyalgia. Nat Clin Pract Rheumatol. 2008;4:392–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Suely Roizenblatt
    • 1
    Email author
  • Nilton Salles Rosa Neto
    • 1
  • Sergio Tufik
    • 1
  1. 1.Departamento de PsicobiologiaUniversidade Federal de São PauloSão PauloBrazil

Personalised recommendations