From the Guidelines
Fibromyalgia treatment should prioritize a multifaceted approach combining medications, lifestyle changes, and therapy, with a focus on improving health-related quality of life and balancing benefit and risk of treatment, as recommended by the EULAR revised recommendations for the management of fibromyalgia 1. The treatment of fibromyalgia typically involves a combination of non-pharmacological and pharmacological interventions.
- Non-pharmacological management options include:
- Aerobic and strengthening exercise, which has been shown to be effective in improving symptoms 1
- Cognitive behavioral therapies, which can help develop pain management strategies 1
- Multicomponent therapies, such as meditation and mindfulness-based stress reduction, which can reduce flare-ups and improve quality of life 1
- Pharmacological management options include:
- Amitriptyline, duloxetine, and milnacipran, which have been shown to be effective in reducing pain and improving function 1
- Pregabalin, which has been shown to be effective in reducing pain and improving sleep quality 1
- Tramadol, which may be used cautiously for breakthrough pain, but opioids are generally avoided due to risk of dependence and limited efficacy 1 It is essential to note that the management of fibromyalgia should be tailored to the individual patient's needs and preferences, and should involve a shared decision-making approach with the patient 1. Regular moderate exercise, cognitive behavioral therapy, and sleep hygiene practices are also crucial in managing fibromyalgia, as they can help improve symptoms and quality of life 1. Stress reduction techniques, such as meditation and deep breathing, can also be beneficial in reducing flare-ups and improving overall well-being 1. Overall, the goal of fibromyalgia treatment is to improve health-related quality of life and reduce symptoms, while minimizing the risk of adverse effects and dependence on medications 1.
From the FDA Drug Label
The efficacy of pregabalin for management of fibromyalgia was established in one 14-week, double-blind, placebo-controlled, multicenter study (F1) and one six-month, randomized withdrawal study (F2) Studies F1 and F2 enrolled patients with a diagnosis of fibromyalgia using the American College of Rheumatology (ACR) criteria (history of widespread pain for 3 months, and pain present at 11 or more of the 18 specific tender point sites). The studies showed a reduction in pain by visual analog scale In addition, improvement was demonstrated based on a patient global assessment (PGIC), and on the Fibromyalgia Impact Questionnaire (FIQ). The efficacy of duloxetine delayed-release capsules for the management of fibromyalgia in adults was established in two randomized, double-blind, placebo-controlled, fixed-dose trials in adult patients meeting the American College of Rheumatology criteria for fibromyalgia
Fibromyalgia Treatment Options:
- Pregabalin: Effective in reducing pain and improving patient global assessment and Fibromyalgia Impact Questionnaire scores 2, 2.
- Duloxetine: Effective in reducing pain and improving function and patient global impression of change in adult patients with fibromyalgia 3. Key Points:
- Pregabalin and duloxetine are both effective treatment options for fibromyalgia.
- Pregabalin studies showed a reduction in pain and improvement in patient global assessment and Fibromyalgia Impact Questionnaire scores.
- Duloxetine studies demonstrated a reduction in pain and improvement in function and patient global impression of change.
From the Research
Fibromyalgia Treatment Options
- Fibromyalgia is a chronic pain disorder characterized by widespread pain, fatigue, and sleep disturbances 4
- Treatment options include medications such as duloxetine, pregabalin, and milnacipran, which have been shown to improve pain, quality of life, and sleep quality 4, 5, 6
- A multidisciplinary approach that incorporates nonpharmacologic therapies and medications is most effective in managing fibromyalgia symptoms 6, 7
Medications for Fibromyalgia
- Duloxetine has been shown to be the most effective treatment, improving pain, quality of life, and sleep quality 4, 8
- Pregabalin is beneficial for pain and sleep management, while milnacipran remains a viable option for those with predominant fatigue 4, 5
- Amitriptyline is also a potentially effective medication for fibromyalgia 6
Nonpharmacologic Therapies
- Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy are first choice treatments for fibromyalgia 5
- Patient education, exercise, and cognitive behavior therapy can improve pain and function 6
- Complementary and alternative therapies such as acupuncture, hypnosis/guided imagery, and Tai Chi may also be beneficial 5
Treatment Approach
- A patient-tailored approach according to the key symptoms is recommended 5
- Treatment should involve the simultaneous application of pharmacological and nonpharmacological treatments 7
- A holistic, comprehensive, multidisciplinary, patient-centered approach is necessary to address the heterogeneity of fibromyalgia symptoms 7