Selecting a Treatment Regimen
ÎOptimal management requires a multidisciplinary approach with a combination of pharmacologic and non-pharmacologic treatment that is tailored according to a patient's pain intensity, level of function, and associated medical and cognitive features (Table 4).4
Pharmacologic Therapies
ÎThree medications have been approved by the U.S. Food and Drug Administration for the treatment of fibromyalgia (Table 5): > Duloxetine HCL (Cymbalta®
> Milnacipran HCL (Savella® > Pregabalin (Lyrica®
) )8, 9, 10 ) ÎA gradual dose reduction is recommended when discontinuing treatment.8, 9
ÎMonitor adolescent and young adult patients taking duloxetine or milnacipran for increased risk of suicidal thinking or behavior.8, 9
ÎCorticosteroids should not be used unless the patient also has a bursa or tendon inflammation.5
ÎDo not use non-steroidal anti-inflammatory drugs (NSAIDs) as primary pain medication. NSAIDs may provide some analgesia when given with other drugs.5
ÎOpioids are not thought to be helpful, and none is FDA approved for fibromyalgia.
ÎAntidepressants are not FDA approved for fibromyalgia. Selective serotonin reuptake inhibitors (SSRIs) carry an increased risk of serotonin syndrome for this condition.
Non-Pharmacologic Therapies
ÎAn individually tailored fitness program, including aerobic exercise and strength training, can help improve pain and function.4
ÎCognitive behavioral therapy (CBT) may be beneficial for some patients. CBT can help improve symptoms including physical functioning, pain and sleep disturbances.
ÎHeated pool treatment ("balneotherapy") with or without exercise is effective in fibromyalgia.4
ÎOther therapies such as relaxation, rehabilitation, "sleep hygiene," physiotherapy and psychological support may be used depending on the needs of the patient.4
ÎDiet and nutrition must be addressed, particularly since some medications can cause weight gain.
