Medication Options for Fibromyalgia: A Comprehensive Review

A Pain Doctor’s diagnosis of Fibromyalgia is: “clinical, and is characterised by widespread pain, tender points, & commonly, comorbid conditions such as chronic fatigue, insomnia & depression. Treatment is largely empiric, although experience & small clinical studies have proved the efficacy of low-dose antidepressant therapy & exercise” [1]

With regards to medication, Pain Doctors frequently prescribe specific antidepressants in order to help relieve sufferers’ pain. Moreover, this form of medication can also be used to ameliorate patients’ emotional well-being, sleep quality, and overall standard of life. There is a broad range of antidepressants on the market. The ones that Pain Consultants often used to treat fibromyalgia, include:

Amitriptyline

This pharmaceutical is classed as a tricyclic antidepressant which is mainly prescribed to treat major depressive disorder, a spectrum of pain syndromes (including neuropathic pain); tension headaches, migraines and fibromyalgia. This drug, which comes in tablet form, and as a liquid, functions by preventing the reuptake of neurotransmitters (for example, serotonin and noradrenaline), thereby modulating the patient’s mood, attention span , and pain. Note: neurotransmitters are chemicals within the body which enable nerve cells (neurons) to communicate with each other throughout the body [2].

Citalopram

This category of antidepressant is known as a SSRI (selective serotonin reuptake inhibitor). SSRIs are typically prescribed to treat patients with anxiety disorders, low mood, major depressive disorder, panic attacks and various other psychological conditions. Pain Doctors my either recommend Citalopram in the form of tablets, or liquid drops which are added to water [2].

Duloxetine

This class of antidepressant medicine which comes in oral capsules, is listed as a SNRI (serotonin-noradrenaline reuptake inhibitor). SNRIs are believed to offer patients relief by increasing their brain’s levels of serotonin and noradrenaline, both of which enhance mood. Note: serotonin and noradrenaline are chemical messengers (neurotransmitters). Both of these chemicals play a crucial role in regulating one’s memory, sleep-wake cycle, and mood. Moreover, serotonin has an impact on sexual desire, appetite, and social behaviour. And noradrenaline increases attention, arousal and alertness. Pain Doctors prescribe Duloxetine to treat nerve pain (including fibromyalgia), as well as anxiety and depression [2].

Fluoxetine (Prozac)

This pharmaceutical serves as a SSRI (selective serotonin reuptake inhibitor). It is frequently prescribed by Pain Doctors to treat depression, and is popular with medics as it has less side-effects then some of the other antidepressants on the market. Your Pain Consultant can prescribe Fluoxetine in the forms of tablets, capsules, or an oral liquid [2].

Sertraline

Also listed as a SSRI (serotonin reuptake inhibitor), Sertraline, which comes in tablet form, is prescribed by Pain Consultants in order to help ameliorate depression. It works by elevating the brain’s level of serotonin, and has less unwanted side effects compared to older antidepressants on the market [2].

Did You Know?

Whilst the term “fibromyalgia” is constantly used by Pain Doctors, it is in fact, fairly new – even though this debilitating condition has been written about in medical papers for hundreds of years. Indeed; “Sir William Gowers coined the term ‘fibrositis’ in 1904. During the next half century, fibrositis was considered by some to be a common cause of muscular pain, by others to be a manifestation of ‘tension’ or ‘psychogenic rheumatism’, & by the rheumatology community, to be a non-entity. The current concept of fibromyalgia was established in 1977. The name change reflected the increasing evidence that there was no –itis or inflammation in the connective tissues of sufferers, but instead –algia or pain” [2].

References

[1]. Millea PJ, Holloway RL. Treating fibromyalgia. Am Fam Physician. 2000 Oct 1;62(7):1575-82, 1587
https://pubmed.ncbi.nlm.nih.gov/11037075/
[2]. NHS (2022). “Treatment: Fibromyalgia.”
https://www.nhs.uk/conditions/fibromyalgia/treatment/

[3]. Harris RE, Clauw DJ. Newer treatments for fibromyalgia syndrome. Ther Clin Risk Manag. 2008 Dec;4(6):1331-42.
ps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643113/