What are the treatment options for Fibromyalgia (Fibromyalgia syndrome)?

From the Guidelines

Fibromyalgia treatment requires a multifaceted approach combining medication, 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 options for fibromyalgia include:

• Medications:
  • First-line medications include duloxetine (Cymbalta) 30-60mg daily, milnacipran (Savella) 50mg twice daily, or pregabalin (Lyrica) 150-450mg daily divided into 2-3 doses, which have been shown to be effective in reducing pain and improving function in patients with fibromyalgia 1.
  • Amitriptyline 10-25mg at bedtime can help with sleep disturbances, which is a common comorbidity in patients with fibromyalgia 1.
• Non-pharmacological treatments:
  • Regular moderate exercise, such as aerobic and strengthening exercise, starting with 10 minutes daily and gradually increasing, which has been shown to be effective in improving function and reducing pain in patients with fibromyalgia 1.
  • Cognitive behavioral therapy (8-12 weekly sessions), which can help patients with fibromyalgia to manage their symptoms and improve their quality of life 1.
  • Stress reduction techniques like meditation or yoga (15-20 minutes daily), which can help to reduce stress and improve sleep quality in patients with fibromyalgia 1.
• Lifestyle changes:
  • Adequate sleep hygiene, including maintaining consistent sleep schedules and avoiding caffeine after noon, which is essential for improving sleep quality and reducing fatigue in patients with fibromyalgia 1.
  • Heat therapy, gentle massage, and acupuncture may provide additional relief for patients with fibromyalgia, although the evidence for these treatments is limited 1. The treatment of fibromyalgia should be individualized and tailored to the patient's needs, 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. Most patients require at least 4-6 weeks of consistent treatment before noticing significant improvement, and treatment typically continues long-term with periodic reassessment of medication effectiveness and side effects 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

The treatment options for Fibromyalgia (Fibromyalgia syndrome) include:

• Pregabalin (PO): total daily doses of 300 mg, 450 mg, and 600 mg
• Duloxetine (PO): 60 mg once daily or 120 mg daily (given in divided doses)

These treatments have been shown to reduce pain and improve patient global assessment and fibromyalgia impact questionnaire scores in clinical trials 2, 2, and 3.

From the Research

Treatment Options for Fibromyalgia

The treatment of fibromyalgia typically involves a multidisciplinary approach, combining pharmacological and nonpharmacological therapies 4.

• Pharmacological Therapies: Several medications have been found to be effective in managing fibromyalgia symptoms, including:
  • Pregabalin, duloxetine, and milnacipran, which are considered first-line treatments 4, 5
  • Amitriptyline and cyclobenzaprine, which may also be used 4
  • Other medications, such as selective serotonin reuptake inhibitors, gabapentin, and tramadol, which may be considered in certain cases 4
• Nonpharmacological Therapies: Nonpharmacological interventions, such as:
  • Patient education
  • Exercise
  • Cognitive behavior therapy can improve pain and function in patients with fibromyalgia 6
• Combination Therapy: Combining medications, such as pregabalin and duloxetine, may be more effective than monotherapy in improving multiple clinical outcomes 7

Medication Efficacy

Studies have shown that:

• Pregabalin can significantly reduce pain and improve sleep quality in patients with fibromyalgia 8
• Duloxetine can improve pain, sleep quality, and quality of life in patients with fibromyalgia 7, 5
• Milnacipran can improve pain and fatigue in patients with fibromyalgia, although its effect on quality of life may be limited 5

Treatment Approach

A multidisciplinary approach, incorporating both pharmacological and nonpharmacological therapies, is recommended for the treatment of fibromyalgia 4, 6.