From the Guidelines
Fibromyalgia treatment should prioritize a multifaceted approach combining non-pharmacological and pharmacological therapies, with a focus on improving health-related quality of life and balancing benefit and risk of treatment, as recommended by the most recent guidelines 1. The management of fibromyalgia should aim at improving health-related quality of life, balancing benefit and risk of treatment, and often requires a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities tailored according to pain intensity, function, associated features, and patient preferences and comorbidities 1.
Non-Pharmacological Management
Non-pharmacological therapies are recommended as the initial management approach, with a focus on:
- Aerobic and strengthening exercise, which has a strong recommendation for improving symptoms 1
- Cognitive behavioral therapies, which have a weak recommendation for improving pain perception and developing coping strategies 1
- Multicomponent therapies, defined physical therapies, and meditative movement therapies, which have varying levels of recommendation for improving symptoms 1
Pharmacological Management
Pharmacological therapies can be added to non-pharmacological therapies as needed, with a focus on:
- Amitriptyline at low dose, duloxetine, milnacipran, and pregabalin, which have weak recommendations for improving pain and function 1
- Tramadol, which has a weak recommendation for improving pain 1 It is essential to note that the management of fibromyalgia should be tailored to the individual patient's needs and preferences, with a focus on improving health-related quality of life and balancing benefit and risk of treatment 1. Some key aspects to consider when managing fibromyalgia include:
- Comprehensive assessment of pain, function, and psychosocial context 1
- Recognition of fibromyalgia as a complex and heterogeneous condition with abnormal pain processing and other secondary features 1
- Multidisciplinary approach to management, including non-pharmacological and pharmacological therapies 1
- Patient education and shared decision-making to improve treatment outcomes 1
From the FDA Drug Label
Studies F1 and F2 enrolled patients with a diagnosis of fibromyalgia using the American College of Rheumatology (ACR) criteria 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): shown to reduce pain by visual analog scale and improve patient global assessment (PGIC), and on the Fibromyalgia Impact Questionnaire (FIQ) 2
- Duloxetine (PO): 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 3
From the Research
Treatment Options for Fibromyalgia
The treatment options for fibromyalgia include:
- Multidisciplinary team efforts using combined treatment approaches, including patient education, aerobic exercise, cognitive behavioral therapy, and pharmacologic therapies 4
- Pharmacologic therapies such as serotonin norepinephrine reuptake inhibitors (e.g., duloxetine, milnacipran) and alpha 2-delta receptor ligands (e.g., pregabalin) 4
- Combination pharmacotherapy, which may provide superior pain relief and possibly fewer side effects 5
- Antidepressants with dual effects on serotonin and norepinephrine (e.g., venlafaxine, duloxetine) for patients with comorbid major depressive disorder or anxiety disorders 6
- Alpha-2-delta ligands (e.g., pregabalin, gabapentin) for patients with anxiety or sleep disturbances associated with fibromyalgia 6
- Amitriptyline, a tricyclic antidepressant, which is widely used to treat fibromyalgia, although the evidence for its efficacy is limited 7
- Nonpharmacological therapies such as education, exercise, and cognitive behavioral therapy, which are supported by high-quality evidence 8
- Pharmacological therapies such as tricyclics, serotonin norepinephrine reuptake inhibitors, and gabapentinoids, which are also supported by high-quality evidence 8
Non-Pharmacological Interventions
Non-pharmacological interventions for fibromyalgia include:
- Patient education 4, 8
- Aerobic exercise 4, 8
- Cognitive behavioral therapy 4, 6, 8
- Cognitive symptoms management 4
- Sleep management 4, 6
Pharmacological Interventions
Pharmacological interventions for fibromyalgia include: