Abstract
Fibromyalgia is a syndrome of widespread pain, nonrestorative sleep, disturbed mood, and fatigue. Optimal treatment involves a multidisciplinary approach with a team of health care providers using pharmacologic and nonpharmacologic treatment. Because of the heterogeneity of the illness, management should be individualized for the patient. Pharmacologic treatment should address issues of pain control, sleep Nonpharmacologic treatment should include patient education, a regular exercise and stretching program, and cognitive behavioral therapy. All of these are essential to improving functional capacity and quality of life. This review provides general guidelines in initiating a successful pharmacologic treatment program for patients with fibromyalgia.
Similar content being viewed by others
References and Recommended Reading
Bennett R: The rational management of fibromyalgia patients. Rheum Dis Clin North Am 2002, 28:181–199.
Wolfe F, Smythe HA, Yunus MB, et al.: The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum 1990, 33:160–172.
Goldenberg DL: Office management of fibromyalgia. Rheum Dis Clin North Am 2002, 28:437–446.
Burckhardt CS, Mannerkorpi K, Hedenberg L, Bjelle AA: Randomized, controlled clinical trial of education and physical training for women with fibromyalgia. J Rheumatol 1994, 21:714–720.
Burckhardt CS, Bjelle AA: Education programs for fibromyalgia patients: description and evaluation. Baillieres Clin Rheumatol 1994, 8:935–955.
Bennett R: Emerging concepts in the neurobiology of chronic pain: evidence of abnormal sensory processing in fibromyalgia. Mayo Clin Proc 1999, 74:385–398. important article summarizing the current evidence to place FM among the central pain states, although acknowledging the importance of peripheral pain generators.
Barkhuizen A: Rational and targeted pharmacologic treatment of fibromyalgia. Rheum Dis Clin North Am 2002, 28:261–290.
Arnold L: Systemic therapies for chronic pain. In Fibromyalgia and Other Central Pain Syndromes. Edited by Wallace D. Baltimore: Lippincott Williams & Wilkins; 2005:365–388. eview of controlled trials of the pharmacologic treatment of FM, with a discussion of current issues that remain to be addressed in further research.
Goldbenberg D, Smith N: Fibromyalgia, rheumatologists, and the medical literature: a shaky alliance. J Rheumatol 2003, 30:151–153.
Goldenberg D, Burckhardt C, Crofford L: Management of fibromyalgia syndrome. JAMA 2004, 292:2388–2395. up-to-date summary of evidence-based guidelines for the treatment of FM.
Arnold LM, Keck PE: Antidepressant treatment of fibromyalgia: a meta-analysis and review. Psychosomatics 2000, 41:104–113.
O’Malley PG, Balden E, Tomkins G, et al.: Treatment of fibromyalgia with antidepressants. J Gen Intern Med 2000, 15:659–666.
Tofferi JK, Jackson JL, O’Malley PG: Treatment of fibromyalgia with cyclobenzaprine: a meta-analysis. Arthritis Rheum 2004, 51:9–13.
Wolfe F, Cathey MA, Hawley DJ: Double-blind, placebo-controlled trial of fluoxetine in fibromyalgia. Scand J Rheumatol 1994, 23:255–259.
Arnold LM, Hess EV, Hudson JI, et al.: Randomized, placebocontrolled, double-blind, flexible-dose study of fluoxetine in the treatment of women with fibromyalgia. Am J Med 2002, 112:191–197.
Goldenberg D, Mayskiy M, Mossey CJ, et al.: Randomized, double-blind, crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum 1996, 39:1852–1859.
Cantini F, Bellandi F, Niccolo L, et al.: Fluoxetine combined with cyclobenzaprine in the treatment of fibromyalgia. Minerva Med 1994, 85:97–100.
Zijsltra TR, Barendregt PJ, Van de Laar MA: Venlafaxine in fibromyalgia: results of a randomized, placebo-controlled, double-blind trial [Abstract]. Arthritis Rheum 2002, 46:S105.
Dwight MM, Arnold LM, O’Brien H, et al.: An open clinical trial of venlafaxine treatment of fibromyalgia. Psychosomatics 1998, 39:14–17.
Sayar K, Aksu G, Ak I, Tosum M: Venlafaxine treatment of fibromyalgia. Ann Pharmacother 2003, 37:1561–1565.
Gendreau RM, Mease PJ, Rao SR, et al.: Milnacipran: a potential new treatment of fibromyalgia [Abstract]. Arthritis Rheum 2003, 48:S616.
Arnold LM, Lu Y, Crofford LJ, et al.: A double-blind, multicenter trial comparing duloxetine to placebo in the treatment of fibromyalgia with or without major depressive disorder. Arthritis Rheum 2004, 50:2974–2984. ely trial of large pharmaceutically sponsored agents in FM with encouraging results.
Rossy LA, Buckelew SP, Dorr N, et al.: A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med 1999, 21:180–191.
Russell IJ: Fibromyalgia syndrome: approaches to management. Bull Rheum Dis 1996, 45:1–4.
Wolfe F, Zhao S, Lane N: Preference for nonsteroidal antiinflammatory drugs over acetaminophen by rheumatic disease patients. Arthritis Rheum 2000, 43:378–385.
Goldenberg DL, Felson DT, Dinerman HA: Randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum 1986, 29:1371–1377.
Biasi G, Manca S, Manganelli S, Marcolongo R: Tramadol in the fibromyalgia syndrome: a controlled clinical trial versus placebo. Int J Clin Pharmacol Res 1998, 18:13–19.
Russell J, Kamin M, Bennet RM, et al.: Efficacy of tramadol in the treatment of pain in fibromyalgia. J Clin Rheumatol 2000, 6:250–257.
Bennett RM, Kamin M, Karin R, Rosenthal N: Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain. Am J Med 2003, 114:537–545.
Petrone D, Kamin M, Olson W: Slowing the titration rate of tramadol HCL reduces the incidence of discontinuation due to nausea and/or vomiting: a double-blind, randomized trial. J Clin Pharm Ther 1999, 24:115–123.
Gasse C, Derby L, Vasilakis-Scaramozza C, Jick H: Incidence of first-time idiopathic seizures in users of tramadol. Pharmacotherapy 2000, 20:629–634.
Mahowald M, Singh JA, Majeski P: Opioid use by patients in an orthopedics spine clinic. Arthritis Rheum 2005, 52:312–321.
Crofford L, Rowbotham M, Mease P, et al.: Pregabalin for the treatment of fibromyalgia syndrome. Arthritis Rheum 2005, 52:1264–1273. important recent trial of a large pharmaceutically sponsored agent
Spath M, Stratz T, Neeck G, et al.: Efficacy and tolerability of intravenous tropisetron in the treatment of fibromyalgia. Scand J Rheumatol 2004, 33:267–270.
Caruso I, Sarzi Puttini P, Cazzola M, Azzolini V: Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res 1990, 18:201–209.
Volkmann H, Norregaard J, Jacobsen S, et al.: Double-blind, placebo-controlled, crossover study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol 1997, 26:206–211.
Bennett RM, Clark SC, Walczyk JA: Randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia. Am J Med 1998, 104:227–231.
Cote KA, Moldofsky H: Sleep, daytime symptoms, and cognitive performance in patients with fibromyalgia. J Rheumatol 1997, 24:2014–2023.
Drewes AM, Nielsen KD, Taagholt SJ, et al.: Sleep intensity in fibromyalgia: focus on the microstructure of the sleep process. Br J Rheumatol 1995, 34:629–635.
Yunus MB, Aldag JC: Restless legs syndrome and leg cramps in fibromyalgia syndrome: a controlled study. Br Med J 1996, 312:1339.
Lin SC, Kaplan J, Burger CD, Fredrickson PA: Effect of pramipexole in the treatment of resistant restless legs syndrome. Mayo Clin Proc 1998, 73:447–450.
Becker PM, Ondo W, Sharon D: Encouraging initial response of restless legs syndrome to pramipexole. Neurology 1998, 51:1221–1223.
Simon GE, VonKorff M: Prevalence, burden, and treatment of insomnia in primary care. Am J Psychiatry 1997, 154:1417–1423.
Coward DM: Tizanidine: neuropharmacology and mechanisms of action. Neurology 1994, 44:S6-S10.
US Modafinil in Narcolepsy Multicenter Study Group: Randomized trial of modafinil as a treatment for the excessive daytime somnolence of narcolepsy. Neurology 2000, 54:1166–1175.
US Modafinil in Narcolepsy Multicenter Study Group: Randomized trial of modafinil for the treatment of pathological somnolence in narcolepsy. Ann Neurol 1998, 43:88–97.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Baker, K., Barkhuizen, A. Pharmacologic treatment of fibromyalgia. Current Science Inc 9, 301–306 (2005). https://doi.org/10.1007/s11916-005-0003-x
Issue Date:
DOI: https://doi.org/10.1007/s11916-005-0003-x