This study explores the life and treatment experience of people in the United Kingdom with fibromyalgia in order to inform the development of treatments which are both effective and acceptable to users. Qualitative interviews were conducted with 14 participants with interpretative phenomenological analysis used as the theoretical framework and analytical method. The themes identified were as follows: Inauthenticity of fibromyalgia, An Unconventional healthcare experience, Re-creating support networks, Challenging the working identity, Threatening the family dynamic and Fighting, accepting or accommodating? The biopsychosocial impacts of fibromyalgia disrupted the identity, lifestyle, roles and relationships of our participants with such challenges further exacerbated by the contested nature of the illness.

Fibromyalgia is a complex chronic condition characterized by pain, physical fatigue, sleep disorder and cognitive impairment. Evidence-based guidelines recommend antidepressants as treatments of fibromyalgia where tricyclics are often considered to have the greatest efficacy, with amitriptyline often being a first-line treatment. Amitriptyline evokes a preferential reduction in pain and fatigue of fibromyalgia, and in the Fibromyalgia Impact Questionnaire (FIQ) score, which is a quality of life assessment. The multimodal profile of the mechanisms of action of amitriptyline include monoamine reuptake inhibition, receptor modulation and ion channel modulation. Several of the actions of amitriptyline on multiple nociceptive and sensory processes at central and peripheral locations have the potential to act cumulatively to suppress the characteristic symptoms of fibromyalgia. Greater understanding of the role of these mechanisms of action of amitriptyline could provide further clues to the pathophysiology of fibromyalgia and to a preferable pharmacological profile for future drug development.

Regulation of potassium (K+) channels evokes hyperpolarization or repolarization of the cell membrane to prevent or reverse cell excitability and is fundamental in the control of cellular activity throughout the range of tissue types within the human body. Genome projects predict that in excess of 80 K+ channel-related genes exist, resulting in a high degree of K+ channel diversity. In addition, dysfunction of K+ channels, as a result of mutations of the genes for the channel proteins or alterations in channel regulation, has been associated with the pathophysiology of diseases. These observations support K+ channels as therapeutic targets to regulate cellular homeostasis in pathophysiological conditions. Molecular cloning and expression of K+ channels offer important information in the identification of selective compounds to provide unique tissue management. Specific modulators have been identified for a limited number of K+ channel subtypes. Unfortunately the conversion of data obtained in the laboratory to success in the clinical setting has been limited. Tissue delivery of genes, in combination with drugs, may be an avenue enabling specific modulation of ion channel function and improved drug selectivity. Using specific examples (HERG, IKs, KCNQs, KCa, Kv1.3), issues regarding distribution, function and diversity related to advances made in the identification of modulators having therapeutic potential are discussed. The scope of this field is just emerging and the number of likely therapeutic indications for K+ channel modulators will increase as insight into the dynamics of expression of these channels in various diseases grows and the issue of the required selectivity is resolved.