Fibromyalgia: Treatment

Commonly used treatments include both nonpharmacologic and drug therapies:

Nonpharmacologic Interventions⁴

Low–impact, incremental, cardiovascular exercise programs (3 times weekly).

Muscle strengthening and flexibility programs. Yoga often serves both purposes.

Hypnotherapy, cognitive behavioral feedback, electromyography (EMG) biofeedback, and meditation programs.

Acupuncture, TENS (transcutaneous electro–nerve stimulator) units, and trigger point needling (or injections with lidocaine). These are all under investigation.

Pharmacologic Interventions

Nonsteroidal anti–inflammatory drugs (NSAIDs) are no better than a placebo when used as monotherapy. However, they may be effective in combination with centrally active medications.

Acetaminophen and/or tramadol in medication–naïve patients may be helpful, but efficacy in other clinical scenarios requires further study.

Cyclobenzaprine and tricyclic antidepressants, such as amitriptyline, may benefit a minority of patients. Efficacy may lessen over time. Small doses with gradual increase are advised, due to undesirable side effects (eg, dry mouth, urinary retention). Desipramine may have milder adverse side effects.

Selective serotonin reuptake inhibitors may be effective in treating pain and may act synergistically with tricyclics.⁵

Duloxetine and milnacipran, which inhibit catecholamine and serotonin reuptake, and carisoprodol (at bedtime), may be beneficial.

Emerging therapeutics, such as anticonvulsants and serotonin receptor blockers, may also be efficacious in treating pain and other symptoms of fibromyalgia.

Narcotics and benzodiazepines are usually contraindicated.

A multidisciplinary approach that includes physical therapy, good sleep hygiene, and mental health specialists may be indicated for optimal treatment, because concomitant depressive symptoms and adjustment problems are often present. Patients also benefit from knowing that a hidden condition is not the cause of their symptoms.