COMMON CONDITIONS - Fibromyalgia Syndrome - FMS Drug Treatment
Drug treatment typically consists of symptom management. Pregabalin and duloxetine are FDA-approved for the management of fibromyalgia.
A minority of patients will have substantial benefit with pregabalin, and more will have moderate benefit. Many will have no or trivial benefit, or will discontinue because of adverse events.
A small number of people benefit significantly from the SNRIs like duloxetine and the tricyclics like amitriptyline; however many people experience more adverse effects than benefits.
Opioids, starting with a weak opioid like tramadol, can be tried but only for patients with moderate to severe pain that is not well-controlled by non-opioid analgesics.
Use of strong opioids is strongly discouraged, and only recommend using them while these drugs continue to provide improved pain and functioning.
Antidepressants are associated with improvements in pain, depression, fatigue, sleep disturbances, and health-related quality of life in patients with FMS.
The goal of antidepressants should be symptom reduction and if used long term, their effects should be evaluated against side effects.
