Fibromyalgia medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

There is no universally accepted treatment for fibromyalgia. Treatment typically consists of symptomic management and the treatment options include medications and cognitive behavioral therapy, which has been shown to be effective in alleviating pain and other fibromyalgia-related symptoms.

Medical Therapy

The medical therapy for fibromyalgia includes analgesics, antidepressants, skeletal muscle relaxants, anticonvulsants, and anti-anxiety medications.

Single agent therapy

• Preferred regimen (1): Amitriptyline 10-70 mg orally once daily at bedtime
• Preferred regimen (2): Cyclobenzaprine 5-30 mg orally once daily at bedtime
• Preferred regimen (3): Duloxetine 30-60 mg orally once daily
• Preferred regimen (4): Milnacipran 12.5 mg orally once daily initially, followed by 12.5 mg twice daily for 2 days, followed by 25 mg twice daily for 4 days, then 50-100 mg twice daily thereafter
• Preferred regimen (5): Pregabalin 75-225 mg orally twice daily, maximum 450 mg/day

Combination Therapy

• Preferred regimen (1): Amitriptyline 10-70 mg orally once daily at bedtime (OR)
• Preferred regimen (2): Cyclobenzaprine 5-30 mg orally once daily at bedtime

AND

• Preferred regimen (3): Duloxetine 30-60 mg orally once daily; higher doses have been used, consult a specialist for guidance (OR)
• Preferred regimen (4): Milnacipran 12.5 mg orally once daily initially, followed by 12.5 mg twice daily for 2 days, followed by 25 mg twice daily for 4 days, then 50-100 mg twice daily thereafter

AND

• Preferred regimen (5): Pregabalin 75-225 mg orally twice daily, maximum 450 mg/day (OR)
• Preferred regimen (6): Gabapentin 300 mg orally once daily on the first day, followed by 300 mg twice daily on the second day, followed by 300 mg three times daily on the third day, then titrate dose according to response up to 1800-2400 mg/day given in 3 divided doses