Fibromyalgia and the Efficacy of Pindolol

Patrick Wood, MD, of the Department of Family Medicine, LSU Health Sciences and Pacific Rheumatology Associates, Inc., believes that when the word fibromyalgia is used, “we’re probably talking about four or even five different clinical entities that all have that label.”

One of those subsets comprises pain which manifests itself through the autonomic nervous system. “Basic science has demonstrated,” they write, “that they type of dysautonomia associated with fibromyalgia results in a state of ‘beta adrenergic-dependent hyperalgesia’ responsive to propranolol, a lipophilic mixed beta adrenergic antagonist.”

Using such findings as the impetus for their investigation of pindolol and fibromyalgia, Wood says that results indicated that “there’s a subset of patients, about a third, who took the medication and had a very remarkable reponse to it in terms of reduction in pain tenderness and the other symptoms that are associated with the disorder.”

However, Wood and co-author Andrew Holman (also of Pacific Rheumatology Associates, Inc.) note that “further work is necessary to determine which patients might benefit from this type of intervention prior to initiation of treatment.”

In discussion about future prospects, Wood comments that two open-label studies have shown good response to pindolol, which he believes will help the use of this pilot data during an application for funding of a blinded study. “The disadvantage,” he says, “is that pindolol is a generic medication so nobody’s going to make any money off of it in the long run. But I think that if you had a well designed study with an inexpensive medication you’re going to have good effects for the patient population.”