What are the treatment options for fibromyalgia?

From the Guidelines

Fibromyalgia treatment should involve 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:

• Non-pharmacological management:
  • Aerobic and strengthening exercise, which has a strong recommendation for improving symptoms 1
  • Cognitive behavioral therapies, which have a weak recommendation for improving symptoms 1
  • Multicomponent therapies, which have a weak recommendation for improving symptoms 1
  • Defined physical therapies, such as acupuncture or hydrotherapy, which have a weak recommendation for improving symptoms 1
• Pharmacological management:
  • Amitriptyline, which has a weak recommendation for improving symptoms 1
  • Duloxetine or milnacipran, which have a weak recommendation for improving symptoms 1
  • Tramadol, which has a weak recommendation for improving symptoms 1
  • Pregabalin, which has a weak recommendation for improving symptoms 1 It is essential to note that the management of fibromyalgia should be tailored according to pain intensity, function, associated features, and patient preferences and comorbidities, and should involve a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities 1. The EULAR revised recommendations for the management of fibromyalgia also emphasize the importance of prompt diagnosis, comprehensive assessment, and shared decision-making with the patient 1. Regular aerobic exercise, cognitive behavioral therapy, sleep hygiene practices, and stress management techniques can also help manage pain perception and associated depression, and reduce symptom flares 1. While there is no cure for fibromyalgia, consistent application of these treatments can significantly improve quality of life and reduce symptom severity, as supported by the EULAR revised recommendations for the management of 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 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 options for fibromyalgia include:
  • Pregabalin (PO)
  • Duloxetine (PO) These medications have been shown to reduce pain and improve function in patients with fibromyalgia, as demonstrated in clinical trials 2, 3, and 2.

From the Research

Treatment Options for Fibromyalgia

The treatment of fibromyalgia typically involves a multidisciplinary approach, combining pharmacological and nonpharmacological therapies 4, 5, 6.

• Pharmacological Therapies: Several medications have been recommended for the treatment of fibromyalgia, including:
  • Pregabalin, duloxetine, and milnacipran, which are considered first-line treatments 4, 5, 7
  • Amitriptyline and cyclobenzaprine, which may be used as alternative options 4
  • Gabapentin, tramadol, and nabilone, which have shown some efficacy in clinical trials 4
• Nonpharmacological Therapies: Nonpharmacological interventions are recommended as the first line of treatment, including:
  • Aerobic exercise 5, 6
  • Cognitive behavioral therapy 5, 6
  • Patient education 5, 6
  • Digital health interventions, combined treatments, and noninvasive neuromodulation, which have shown promise in recent studies 6
• Combination Therapy: Combining different therapies, whether pharmacological or nonpharmacological, may be the most effective strategy for managing symptoms in patients with fibromyalgia 4, 6

Medication Use Patterns

Studies have shown that patients with fibromyalgia often have multiple comorbidities and use a variety of medications, including opioids, benzodiazepines, and muscle relaxants 8.

• Dose and Duration: The dose of medications such as amitriptyline, duloxetine, gabapentin, and pregabalin may not be increased in most patients during the follow-up period, and treatment is often discontinued after a short period 8
• Efficacy and Safety: The efficacy and safety of different medications for fibromyalgia have been evaluated in several studies, with duloxetine showing significant improvements in pain, quality of life, and sleep quality 7