Prednisone Should Not Be Used for Fibromyalgia Flares
Corticosteroids, including prednisone, have no role in the treatment of fibromyalgia and should be avoided due to high risk of harm without benefit. 1
Why Steroids Are Contraindicated
Fibromyalgia is not an inflammatory condition—it is a centralized pain syndrome characterized by abnormal pain modulation and central sensitization, not tissue inflammation that would respond to corticosteroids. 1
Steroids should be explicitly avoided in fibromyalgia management due to the high risk of abuse, severe side effects, and lack of efficacy for the underlying pathophysiology. 1
The evidence base for fibromyalgia treatment includes antidepressants, anticonvulsants, and nonpharmacological interventions, but no controlled trials support corticosteroid use. 2, 3
Critical Diagnostic Consideration
If a patient with presumed "fibromyalgia" appears to require or respond to prednisone, the diagnosis must be reconsidered immediately. This clinical scenario suggests an inflammatory rheumatic condition (such as polymyalgia rheumatica, rheumatoid arthritis, or inflammatory myopathy) rather than fibromyalgia. 4
- Polymyalgia rheumatica, for example, requires 12.5-25 mg/day prednisone and shows dramatic improvement within 2-4 weeks. 4
- Fibromyalgia does not respond to this approach and the patient will accumulate steroid toxicity without symptom relief. 1
Evidence-Based Treatment for Fibromyalgia Flares
The appropriate management strategy involves:
Exercise therapy (aerobic, strengthening, or mind-body exercises) improves pain (effect size -0.72 to -0.96), depression, fatigue, and sleep. 5
Psychological interventions (cognitive-behavioral therapy or mindfulness) improve pain, sleep, and depression (effect size -0.35 to -0.55). 5
Pharmacological options with evidence include duloxetine (serotonin-norepinephrine reuptake inhibitor) or pregabalin (alpha-2-delta ligand), not corticosteroids. 3, 1
Multidisciplinary approach combining pharmacotherapy with education, aerobic exercise, and cognitive-behavioral therapy provides the most effective symptom control. 2, 6
Common Pitfall to Avoid
Do not prescribe prednisone for fibromyalgia under any circumstances—this represents either a diagnostic error (missing an inflammatory condition) or inappropriate treatment that will cause iatrogenic harm including weight gain, hyperglycemia, osteoporosis, hypertension, and hypothalamic-pituitary-adrenal axis suppression without addressing the patient's symptoms. 1