In Reply: We would like to thank the Drs. Abeles for reading our paper 1 and providing valuable input. We are, however, surprised by their question as to who the “many” people are who believe that pregabalin is an important advance in the treatment of fibromyalgia. Anyone who is involved in taking care of fibromyalgia patients would know that several patients regularly report being helped by this medication to a varying degree. These patients rightly believe that this drug—the first drug approved by the US Food and Drug Administration for their oft-misunderstood condition—has started a much-needed dialogue in the medical community, and that in itself is a major advance.
We accept that Gowers, in his original paper on “fibrositis,” believed that fibrous tissue and not muscle was the source of inflammation in this condition.
We do believe that the paper by Russell et al 2 was one of the many investigations that helped establish the role of central sensitization or abnormalities in pain processing in the central nervous system as the root cause of fibromyalgia pain. However, we do not believe our paper on pregabalin was the right place to discuss the merits or shortcomings of that paper in any more detail.
As we mentioned in our paper, therapies for fibromyalgia have limitations, and duloxetine and milnacipran are no exceptions. However, both these drugs were approved after our review was completed. We believe that the role of pregabalin in the treatment of fibromyalgia is going to be limited simply because medications overall form a small part of the comprehensive program of therapy for this condition.