Fibromyalgia Remains a Controversial Medical Enigma/IN REPLY

摘要

In a double-blind trial comparing duloxetine with placebo, patients taking duloxetine measured significantly better on the Fibromyalgia Impact Questionnaire (FIQ) total score, but there was no difference on the FIQ subscales of pain, fatigue, or morning fatigue.4 As pain is the major clinical feature of fibromyalgia, it is not clear how the authors defined effectiveness. Family physicians also should consider vitamin D deficiency when evaluating patients with diffuse truncal pain.1-3 Vitamin D deficiency is common in N north America because of inadequate sun exposure (especially for those who live above 39 degrees of latitude) and intake.n8 As mentioned above, readers should understand that this article does not constitute a practice guideline. Administration of cytochrome (CYP) P450 2D6-inhibiting drugs increases the risk of adverse reactions, especially in patients taking certain medications; physicians prescribing any medication should be aware of the dosage, indications, interactions, and adverse effects of the medications used and should weigh the risks and benefits before prescribing the medication. A Cochrane Review on antidepressant and centrally active agents for the treatment of fibromyalgia is currently in progress.9 We thank Dr. Richardson for his excellent point about considering Vitamin D deficiency in the differential diagnosis of patients with fibromyalgia.