From the Guidelines
The recommended treatment for fibromyalgia involves a multifaceted approach combining medication, exercise, and psychological therapies, with a focus on non-pharmacological therapies as the initial management strategy, as stated in the 2017 EULAR revised recommendations for the management of fibromyalgia 1.
Key Components of Treatment
- Medications:
- Amitriptyline (at low dose), duloxetine or milnacipran, and pregabalin are recommended with a weak strength of recommendation for 100% or close to 100% of the working group 1.
- Other medications that may help include tramadol and cyclobenzaprine, although the strength of recommendation may vary.
- Exercise:
- Aerobic and strengthening exercise is strongly recommended with a high level of evidence (Ia) and a strong strength of recommendation for 100% of the working group 1.
- Starting with 5-10 minutes daily of walking, swimming, or gentle yoga, gradually increasing to 30 minutes most days.
- Psychological Therapies:
- Cognitive behavioral therapies are recommended with a high level of evidence (Ia) and a weak strength of recommendation for 100% of the working group 1.
- Multicomponent therapies, defined physical therapies, and meditative movement therapies may also be beneficial, although the strength of recommendation varies.
Additional Considerations
- Sleep hygiene practices are essential, including maintaining consistent sleep schedules and creating a comfortable sleep environment.
- Stress reduction techniques such as meditation, deep breathing, or progressive muscle relaxation practiced for 10-15 minutes daily can also provide relief.
- A multidisciplinary approach, tailored to the individual patient's needs, is crucial for effective management of fibromyalgia, as emphasized in both the 2017 1 and 2008 1 EULAR recommendations.
From the FDA Drug Label
The recommended duloxetine delayed-release capsule dosage is 60 mg once daily in adults with fibromyalgia. Begin treatment at 30 mg once daily for 1 week, to allow patients to adjust to duloxetine delayed-release capsules before increasing to 60 mg once daily. The recommended dose of pregabalin capsules for fibromyalgia is 300 mg to 450 mg/day. Begin dosing at 75 mg two times a day (150 mg/day). The dose may be increased to 150 mg two times a day (300 mg/day) within 1 week based on efficacy and tolerability
Recommended Treatment for Fibromyalgia:
- Duloxetine: 60 mg once daily, starting at 30 mg once daily for 1 week
- Pregabalin: 300 mg to 450 mg/day, starting at 75 mg two times a day (150 mg/day)
Key Points:
- Both duloxetine and pregabalin are recommended for the treatment of fibromyalgia
- The dosage of duloxetine is 60 mg once daily, while the dosage of pregabalin is 300 mg to 450 mg/day
- It is essential to start with a lower dose and gradually increase as needed and tolerated 2, 3
From the Research
Treatment Options for Fibromyalgia
The treatment of fibromyalgia often involves a combination of medications, lifestyle changes, and alternative therapies. Some of the commonly used medications for fibromyalgia include:
- Amitriptyline, a tricyclic antidepressant, which has been shown to have some benefit in reducing pain and improving sleep quality 4
- Pregabalin, an anticonvulsant, which has been approved for the treatment of fibromyalgia and has been shown to be effective in reducing pain and improving sleep quality 5, 6
- Duloxetine, a serotonin and noradrenaline reuptake inhibitor (SNRI), which has been shown to be effective in reducing pain and improving quality of life 5, 7
- Milnacipran, another SNRI, which has been shown to be effective in reducing pain and improving quality of life 5, 7
Efficacy of Treatment Options
The efficacy of these treatment options has been studied in several clinical trials. For example:
- A study published in 2024 found that duloxetine was the most effective treatment for fibromyalgia, improving pain, quality of life, and sleep quality 5
- A study published in 2019 found that amitriptyline had some benefit in reducing pain and improving sleep quality, but the evidence was of low quality and the treatment effect was small 4
- A study published in 2018 found that duloxetine and milnacipran had some benefit in reducing pain and improving quality of life, but the evidence was of low quality and the treatment effect was small 7
Safety and Tolerability of Treatment Options
The safety and tolerability of these treatment options have also been studied. For example:
- A study published in 2018 found that duloxetine and milnacipran had a higher risk of adverse events, including nausea, insomnia, and somnolence, compared to placebo 7
- A study published in 2019 found that amitriptyline had a higher risk of adverse events, including dry mouth, dizziness, and constipation, compared to placebo 4
Key Findings
Some key findings from the studies include:
- Duloxetine and milnacipran have been shown to be effective in reducing pain and improving quality of life, but the evidence is of low quality and the treatment effect is small 5, 7
- Amitriptyline has been shown to have some benefit in reducing pain and improving sleep quality, but the evidence is of low quality and the treatment effect is small 4
- Pregabalin has been shown to be effective in reducing pain and improving sleep quality, and is generally well-tolerated 5, 6