What are the treatment options for fibromyalgia?

From the Guidelines

Fibromyalgia treatment should prioritize a multifaceted approach combining medication, lifestyle changes, and therapy, with first-line medications including duloxetine, milnacipran, or pregabalin, as recommended by the most recent guidelines 1. The treatment of fibromyalgia requires a comprehensive approach that addresses both the physical and psychological aspects of the condition.

• Medications such as duloxetine (Cymbalta) 30-60mg daily, milnacipran (Savella) 50mg twice daily, or pregabalin (Lyrica) 150-450mg daily divided into multiple doses are considered first-line treatments 1.
• Amitriptyline 10-25mg at bedtime can be used to help with sleep disturbances, although its use should be judicious in older adults due to the risk of confusion and falls 1.
• Regular moderate exercise, starting with 5-10 minutes daily and gradually increasing to 30 minutes most days, is crucial for improving function and quality of life 1.
• Cognitive behavioral therapy (CBT) for 8-12 sessions can help patients develop pain management strategies and improve their overall well-being 1.
• Sleep hygiene practices, such as maintaining consistent sleep schedules and avoiding caffeine after noon, are essential for managing sleep disturbances associated with fibromyalgia.
• Stress reduction techniques, including meditation, deep breathing exercises, or progressive muscle relaxation for 10-15 minutes daily, can significantly reduce pain flares and improve quality of life. These treatments work together to address the complex pathophysiology of fibromyalgia, including neurological pain processing abnormalities and psychological aspects of chronic pain.
• Most patients require at least 4-6 weeks of consistent treatment before noticing significant improvement, and treatment typically continues long-term with periodic reassessment 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

The treatment options for fibromyalgia include:

• Pregabalin: total daily doses of 300 mg, 450 mg, and 600 mg have been studied, with 450 mg daily dose showing the most improvement in pain scores.
• Duloxetine: 60 mg once daily or 120 mg daily (given in divided doses) have been shown to statistically significantly improve endpoint mean pain scores from baseline and increase the proportion of patients with at least a 50% reduction in pain score from baseline. 2, 2, 3

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 also be effective 4
  • Low-dose naltrexone, which has shown promise in small pilot studies 8
  • 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:
  • Aerobic exercise 5, 6
  • Cognitive behavioral therapy 5, 6
  • Multicomponent therapy 6
  • Acupuncture, hypnosis, and Tai Chi, which may be recommended as complementary and alternative therapies 6
• Combination Therapy: Combination therapy, using multiple medications and nonpharmacological interventions, may be necessary to effectively manage the complex symptoms of fibromyalgia 4, 7