What are the treatment options for fibromyalgia?

From the Guidelines

Treatment for fibromyalgia should involve a multidisciplinary approach, combining non-pharmacological and pharmacological therapies tailored to the patient's needs, with a focus on improving health-related quality of life. According to the EULAR revised recommendations for the management of fibromyalgia 1, the management of fibromyalgia should aim at improving health-related quality of life, balancing benefit and risk of treatment, and often requires a combination of non-pharmacological and pharmacological treatment modalities.

Non-Pharmacological Management

The recommended non-pharmacological therapies include:

• Aerobic and strengthening exercise, with a strong recommendation for 100% of patients 1
• Cognitive behavioral therapies, with a weak recommendation for 100% of patients 1
• Multicomponent therapies, with a weak recommendation for 93% of patients 1
• Defined physical therapies such as acupuncture or hydrotherapy, with a weak recommendation for 93% of patients 1
• Meditative movement therapies (qigong, yoga, tai chi) and mindfulness-based stress reduction, with a weak recommendation for 71-73% of patients 1

Pharmacological Management

The recommended pharmacological therapies include:

• Amitriptyline (at low dose), with a weak recommendation for 100% of patients 1
• Duloxetine or milnacipran, with a weak recommendation for 100% of patients 1
• Tramadol, with a weak recommendation for 100% of patients 1
• Pregabalin, with a weak recommendation for 94% of patients 1
• Cyclobenzaprine, with a weak recommendation for 75% of patients 1

Testing for Fibromyalgia

While there is no single test to diagnose fibromyalgia, a comprehensive assessment of pain, function, and psychosocial context is essential for diagnosis and management 1. The diagnosis of fibromyalgia is typically based on a combination of clinical evaluation, medical history, and physical examination.

Key Considerations

It is essential to recognize fibromyalgia as a complex and heterogeneous condition, and management should be tailored to the individual patient's needs, taking into account pain intensity, function, associated features, fatigue, sleep disturbance, and patient preferences and comorbidities 1. A shared decision-making approach with the patient is crucial in developing an effective treatment plan.

From the FDA Drug Label

The efficacy of milnacipran hydrochloride for the management of fibromyalgia was established in two double-blind, placebo-controlled, multicenter studies in adult patients (18 to 74 years of age) Enrolled patients met the American College of Rheumatology (ACR) criteria for fibromyalgia (a history of widespread pain for 3 months and pain present at 11 or more of the 18 specific tender point sites).

The treatment options for fibromyalgia include milnacipran hydrochloride, which has been shown to be effective in reducing pain and improving patient global assessment.

• The American College of Rheumatology (ACR) criteria for fibromyalgia are used to diagnose the condition, which includes a history of widespread pain for 3 months and pain present at 11 or more of the 18 specific tender point sites.
• Milnacipran hydrochloride has been studied in two double-blind, placebo-controlled, multicenter studies, which demonstrated its efficacy in managing fibromyalgia. Testing for fibromyalgia involves meeting the ACR criteria, which includes a history of widespread pain and pain present at 11 or more of the 18 specific tender point sites 2.

From the Research

Treatment Options for Fibromyalgia

The treatment options for fibromyalgia can be categorized into pharmacological and non-pharmacological interventions.

• Non-pharmacological interventions are recommended as first-line treatment for fibromyalgia 3.
• These interventions include exercise, psychological treatments, multidisciplinary modality, balneotherapy, and massage, which have been shown to improve symptoms and disease-specific quality of life 3.
• Exercise, in particular, has been found to improve pain, depression, fatigue, and sleep, with different forms of exercise having varying effects on these symptoms 3.
• Psychological treatments, such as cognitive behavioral therapy and mindfulness, have also been shown to improve symptoms, including pain, sleep, and depression 3.

Pharmacological Treatment Options

Pharmacological treatment options for fibromyalgia include:

• Antidepressants
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Opioids
• Sedatives
• Muscle relaxants
• Antiepileptics 4, 5
• However, no single drug is capable of fully managing the constellation of fibromyalgia symptoms, and an individualized, multimodal approach that includes both pharmacologic and non-pharmacologic therapies seems to be the most appropriate treatment strategy 4, 5.

Complementary Treatment Options

Complementary treatment options for fibromyalgia include:

• Acupuncture, which has been shown to reduce pain and improve quality of life 6
• Patient education
• Cognitive-behavioral therapy
• Relaxation techniques
• Complementary and alternative medicine 7
• These interventions can be used in conjunction with pharmacological and non-pharmacological treatments to provide a comprehensive treatment approach.