From the Guidelines
Treatment for a fibromyalgia flare should prioritize a combination of non-pharmacological and pharmacological approaches, focusing on improving health-related quality of life and balancing benefits and risks of treatment, as recommended by the EULAR revised recommendations for the management of fibromyalgia 1. The management of fibromyalgia should aim at improving health-related quality of life, and this can be achieved through a multidisciplinary approach that includes both non-pharmacological and pharmacological treatment modalities. Some key non-pharmacological management options include:
- Aerobic and strengthening exercise, which has a strong recommendation for improving symptoms 1
- Cognitive behavioral therapies, which can help patients cope with the condition
- Multicomponent therapies, such as meditation and mindfulness-based stress reduction, which can help reduce stress and improve overall well-being
- Defined physical therapies, such as acupuncture or hydrotherapy, which can help reduce pain and improve function Pharmacological management options may include:
- Amitriptyline at low dose, which has a weak recommendation for improving symptoms 1
- Duloxetine or milnacipran, which can help reduce pain and improve function
- Pregabalin, which can help reduce pain and improve sleep quality
- Cyclobenzaprine, which can help reduce muscle tension and improve sleep quality It's essential to note that the management of fibromyalgia should be tailored to the individual patient's needs and preferences, and a shared decision-making approach with the patient is recommended 1. The EULAR revised recommendations for the management of fibromyalgia provide a comprehensive framework for the management of fibromyalgia, and healthcare professionals should consider these recommendations when developing treatment plans for patients with fibromyalgia 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) 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 Treatment with duloxetine delayed-release capsules 60 mg or 120 mg daily statistically significantly improved the endpoint mean pain scores from baseline and increased the proportion of patients with at least a 50% reduction in pain score from baseline
Treatment options for fibromyalgia flare:
- Pregabalin: total daily doses of 300 mg, 450 mg, and 600 mg
- Duloxetine: 60 mg once daily or 120 mg daily (given in divided doses) Key points:
- Reduction in pain by visual analog scale
- Improvement in patient global assessment (PGIC) and Fibromyalgia Impact Questionnaire (FIQ)
- At least a 50% reduction in pain score from baseline 2 3
From the Research
Treatment Options for Fibromyalgia Flare
The treatment of fibromyalgia flare involves a multidisciplinary approach, including pharmacological, psychological, and physical therapies.
- Pharmacological Treatment:
- Pregabalin, duloxetine, and milnacipran are commonly used medications for managing pain, quality of life, and sleep quality in fibromyalgia patients 4.
- A combination of carisoprodol, paracetamol, and caffeine has also been shown to be effective in improving pain, sleep quality, and general feeling of sickness 5.
- Psychological Treatment:
- Cognitive-behavioral therapy (CBT) is a recommended psychological treatment for fibromyalgia, which can help reduce pain catastrophizing and improve overall well-being 6.
- Mind-body techniques, such as biofeedback, hypnosis, and CBT, have been found to be effective in treating fibromyalgia when used as part of a multidisciplinary approach 7.
- Physical Therapy:
- Cardiovascular fitness training, physiotherapy, and modalities like whole body cryotherapy, trigger point injection, massage, acupuncture, and biofeedback may help reduce disease consequences such as pain, fatigue, and sleep disturbances 8.
- A multidisciplinary approach combining these therapies in a well-balanced program is currently recommended for the treatment of fibromyalgia 8.
It is essential to note that each patient may respond differently to these treatments, and a personalized approach is necessary to manage fibromyalgia symptoms effectively.