In an effort to reduce fibromyalgia symptoms, a number of medications have been tried with mixed results (see Table 1.0). For instance, duloxetine was originally developed to manage depression, whereas now it is used in the treatment and management of fibromyalgia. According to compilations of data from six trials, when duloxetine was compared with placebo among 2000 individuals with the illness, those who had taken the drug displayed a significant improvement in reduction of pain (Lunn, Hughes, & Wiffen, 2014). However, in clinical studies, some of the side effects associated with duloxetine included dry mouth, nausea, reduced appetite, sleepiness, constipation, sweating and increased suicidal thinking. Other likely side effects included muscle aches, vomiting, diarrhea, stomachache, and tremor (Häuser, Walitt, Fitzcharles, & Sommer, 2014). Furthermore, duloxetine is not recommended for patients with severe or hepatic renal insufficiency, in addition to individuals with heavy alcohol consumption, due to the danger of liver damage (Guymer & Littlejohn, 2018).

Pregabalin is used mainly to manage general pain. Those with fibromyalgia have high levels of glutamine in their insula region of the brain, and pregabalin reduces these levels, resulting in reduced pain (Harris, Napadow & Huggins, 2013). The common side effects of pregabalin include drowsiness, blurry vision, feet seizure, swelling hands, weight gain, and drowsiness. If drowsiness is noticeable, individuals may benefit by taking pregabalin at night to improve sleep and reduce day drowsiness (Häuser et al., 2014). Treatment interactions are rare, and pregabalin can safely be taken along with tricyclic, antidepressants and most analgesics. This drug is most effective for individuals with prominent sleep disturbance and pain, and less effective for patients with fatigue (Häuser, Clauw, & Fitzcharles, 2017).

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Milnacipran is another treatment used in the management of fibromyalgia. Although milnacipran has the same side effects profile as duloxetine, it is known to be more stimulating (Bateman, Palmer, Trugman, & Lin, 2013). Milnacipran increases the activities of the neurotransmitters in the brain which take part in filtering pain signals traveling within the spinal cord. Thus, when using milnacipran, fewer pain signals move to the brain, meaning the brain cannot signal the rest of the body to feel pain. Outcomes collaborations of data show that milnacipran is more effective than selective SSRIs and can be used in the treatment of major depression (Palmer, Periclou, & Banerjee, 2013). Additionally, milnacipran has a lower risk of drug interactions compared to SSRIs and conventional antidepressants. Since many patients with these syndromes take medications like analgesics, milnacipran may be beneficial for such individuals. These side effects include suicidal actions and thoughts, nausea, constipation, dizziness, insomnia, vomiting, excessive sweating, palpitations, and high blood pressure.

Amitriptyline (AMT) is a tricyclic antidepressant drug acknowledged for a long time in the management of fibromyalgia and neuropathic pain. AMT has been reviewed by the Association of the Scientific Medical Societies in Germany (AWMF), Canadian guidelines, and the European League Against Rheumatism (EULAR). AMT has been recommended by AWMF (10 mg to 50 mg a day), whereas EULAR only recommends two prescription medications, though with a high degree of agreement (Kia & Choy, 2017). The Canadian guidelines use a broader approach to amitriptyline and vouch for all groups of antidepressants for the management of fibromyalgia symptoms subject to the effectiveness of the medication, patient’s characteristics, doctor’s knowledge and cost. The side effects of the drug include diarrhea, constipation, vomiting, nausea, weight changes and appetite changes. Also, the drug can cause suicidal thoughts and electrolyte imbalance (hypernatremia).

Bateman, L., Palmer, R., Trugman, J., & Lin, Y. (2013). Results of switching to milnacipran in fibromyalgia patients with an inadequate response to duloxetine: a phase IV pilot study. Journal of pain research , 6, 311.

Guymer, E., & Littlejohn, G. (2018). Pharmacological treatment options for fibromyalgia. Stroke , 13 , 57.

Harris, R., Napadow, V., Huggins, J. Pauer, L., Kim, J. (2013). Pregabalin rectifies aberrant brain chemistry, connectivity, and functional response in chronic pain patients. Anesthesiology 119(6):1453–1464. doi: 10.1097/aln.0000000000000017

Häuser, W., Clauw, D. J., & Fitzcharles, M. A. (2017). Treat‐to‐Target Strategy for Fibromyalgia: Opening the Dialogue. Arthritis care & research , 69 (4), 462-466.

Häuser, W., Sarzi-Puttini, P., Tölle, T. R., & Wolfe, F. (2012). Placebo and nocebo responses in randomised controlled trials of drugs applying for approval for fibromyalgia syndrome treatment: systematic review and meta-analysis. Clinical Experimental Rheumatology , 30(6 Suppl 74), 78-87.

Häuser, W., Walitt, B., Fitzcharles, M. A., & Sommer, C. (2014). Review of pharmacological therapies in fibromyalgia syndrome. Arthritis research & therapy , 16 (1), 201.

Kia, S., & Choy, E. (2017). Update on treatment guideline in fibromyalgia syndrome with focus on pharmacology. Biomedicines , 5(2), 20.

Lunn, M., Hughes, R. A., & Wiffen, P. J. (2014). Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. The Cochrane Library .

Palmer, R. H., Periclou, A., & Banerjee, P. (2013). Milnacipran: a selective serotonin and norepinephrine dual reuptake inhibitor for the management of fibromyalgia . Therapeutic advances in musculoskeletal disease , 2(4), 201-220