Sections

Fibromyalgia

Medication

Medication Summary

Medication use in patients with fibromyalgia should always be combined with nonpharmacologic therapy. Japanese and German guidelines recommend that pediatric patients receive nonpharmacologic treatment exclusively.^{[165, 166]}

The US Food and Drug Administration (FDA) has approved three drugs for use in fibromyalgia: pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella).^[128]Pregabalin is used to reduce pain and improve sleep. The antidepressants duloxetine and milnacipran, which are used to relieve pain, fatigue, and sleep problems, are generally used at lower doses than for treatment of depression.

Other anticonvulsants and antidepressants are often used off-label to treat fibromyalgia and there is evidence that many can decrease pain sensitivity. Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) are useful only for management of coexisting inflammatory processes and are not recommended as first-line therapies. Pharmacologic and nonpharmacologic treatment of poor sleep is crucial for improving the patient's overall sense of well-being.

Several medications should be avoided or used carefully. Opioids, hypnotics, anxiolytics, and certain skeletal-muscle relaxants must be used with caution because of the potential for abuse and the risk of worsening fatigue and cognitive dysfunction.

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who experience pain.

Tramadol (Ultram, Ryzolt, Rybix)

View full drug information

Tramadol is a centrally acting analgesic indicated for moderately severe pain. This agent inhibits ascending pain pathways, altering the perception of and response to pain. Tramadol also inhibits reuptake of norepinephrine and serotonin.

Class Summary

Agents of varying durations of action are used frequently for anxiety and panic and as sleep aids (poor sleep is nearly universal in fibromyalgia).^[114]Antianxiety agents are often used in combination with antidepressants and anticonvulsant drugs.

Alprazolam (Xanax, Niravam)

View full drug information

Alprazolam binds receptors at several sites within the central nervous system (CNS), including the limbic system and reticular formation. Effects may be mediated through the gamma-aminobutyric acid (GABA) receptor system. It has a short half-life (< 12 h).

Clonazepam (Klonopin)

View full drug information

Clonazepam suppresses muscle contractions by facilitating inhibitory GABA neurotransmission and other inhibitory transmitters. It has a long half-life (25-100 h).

Zolpidem (Ambien)

View full drug information

Zolpidem is indicated for insomnia. It is structurally dissimilar to benzodiazepines but similar in activity, with the exception of having reduced effects on skeletal muscle and seizure threshold.

Zaleplon (Sonata)

View full drug information

Zaleplon interacts selectively with the GABA receptor. It binds to the omega-1 receptor situated on the alpha subunit of the GABA-A receptor complex in the brain.

Trazodone (Oleptro)

View full drug information

Trazodone is useful as an alternative to improve sleep and to treat anxiety and panic disorders that may be associated with fibromyalgia. It is an antagonist at the 5-HT2 receptor and inhibits the reuptake of 5-HT. It also has negligible affinity for cholinergic and histaminergic receptors. In animals, trazodone selectively inhibits serotonin uptake by brain synaptosomes and potentiates behavioral changes induced by the serotonin precursor 5-hydroxytryptophan.

Buspirone

View full drug information

This agent is a 5-HT1 agonist with serotonergic neurotransmission and some dopaminergic effects in the CNS. It has an anxiolytic effect but may take as long as 2-3 wk for full efficacy.

Temazepam (Restoril)

View full drug information

Temazepam is indicated for insomnia. It depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

Sodium Oxybate (Xyrem)

View full drug information

Sodium oxybate acts as an inhibitory chemical transmitter in the brain through specific receptors for gamma hydroxybutyrate (GHB) and GABA.

Class Summary

These agents have modest short-term benefit as adjunctive therapy for nociceptive pain associated with muscle strains and, used intermittently, for diffuse and certain regional chronic pain syndromes. With the exception of cyclobenzaprine, long-term improvement over placebo has not been established for muscle relaxants in fibromyalgia, and they are not recommended. Cyclobenzaprine can be helpful for sleep and pain control as a single nighttime dose in combination with an anxiolytic/hypnotic agent.

Cyclobenzaprine (Flexeril, Flexmid)

View full drug information

Cyclobenzaprine acts centrally and reduces motor activity of tonic somatic origins, influencing both alpha and gamma motor neurons. This agent is structurally related to tricyclic antidepressants (TCAs) and, thus, carries some of the same liabilities.

Class Summary

Low-dose TCAs have proven to have short-term efficacy for pain control, improved sleep, and improved sense of well-being in patients with fibromyalgia. However, adverse effects (eg, dry mouth, drowsiness, weight gain) limit patient acceptance.

Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), fluvoxamine, paroxetine (Paxil, Pexeva), and sertraline (Zoloft), improve symptoms in fibromyalgia but have largely been replaced as a treatment for pain by dual serotonin/norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor), desvenlafaxine (Pristiq), milnacipram (Savella),^[136]or duloxetine (Cymbalta).^{[137, 138, 139]}

Milnacipram has been approved for use in fibromyalgia by the FDA. Duloxetine has been shown to improve pain in fibromyalgia irrespective of comorbid depression^[140]and is currently approved by the FDA for pain in fibromyalgia.

A useful combination is a TCA (eg, amitriptyline or cyclobenzaprine in low dosage at bedtime) and an SNRI. Patients taking either SSRIs or SNRIs should be carefully monitored for worsening depression or emergence of suicidal thoughts.

Amitriptyline

View full drug information

Amitriptyline inhibits the reuptake of serotonin and/or norepinephrine at presynaptic neuronal membrane, which increases their concentration in the CNS.

Duloxetine (Cymbalta)

View full drug information

Duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake. Its antidepressive action is theorized to be due to serotonergic and noradrenergic potentiation in CNS. It is indicated for fibromyalgia in adults and adolescents aged 13-17 y.

Milnacipran (Savella)

View full drug information

Milnacipran is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI). Its exact mechanism of central pain inhibitory action and ability to improve symptoms of fibromyalgia remain unknown. It is indicated for fibromyalgia.

Venlafaxine (Effexor, Effexor XR)

View full drug information

Vanlafaxine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake.

Desvenlafaxine (Pristiq)

View full drug information

Desvenlafaxine inhibits neuronal serotonin and norepinephrine reuptake.

Levomilnacipran (Fetzima)

View full drug information

A potent inhibitor of neuronal serotonin and norepinephrine reuptake, levomilnacipran inhibits norepinephrine uptake with ~3-fold higher potency in vitro than serotonin, without directly affecting the uptake of dopamine or other neurotransmitters

Class Summary

These agents are useful for chronic pain states, including fibromyalgia and related syndromes and various types of neuropathic pain, and serve as adjunctive medications for disturbed sleep and depression. Multiple choices are available, including gabapentin (Neurontin),^[145]tiagabine (Gabitril), and the more recently released pregabalin (Lyrica),^{[146, 172, 147, 122]}which has been particularly well-studied in fibromyalgia.

Pregabalin (Lyrica)

View full drug information

Pregabalin is a structural derivative of GABA. Its mechanism of action is unknown. Pregabalin binds with high affinity to alpha2-delta site (a calcium channel subunit). In vitro, it reduces calcium-dependent release of several neurotransmitters, possibly by modulating calcium channel function. This agent is FDA approved for neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, or fibromyalgia. It is also indicated as adjunctive therapy in partial-onset seizures.

Gabapentin (Neurontin)

View full drug information

Gabapentin is effective for pain and associated depressed mood and anxiety. It has anticonvulsant properties and antineuralgic effects; however, its exact mechanism of action is unknown. Gabapentin is structurally related to GABA but does not interact with GABA receptors. Titration to effect can take place over several days to weeks.

Tiagabine (Gabitril)

View full drug information

This drug enhances GABA activity by inhibiting uptake in neurons and astrocytes.

Class Summary

Clonidine is helpful in controlling withdrawal symptoms during tapering of opioids, which may take 2-3 weeks or longer.

Clonidine (Catapres, Kapvay)

View full drug information

Clonidine stimulates alpha-2 adrenoreceptors in the brain stem, activating an inhibitory neuron, which, in turn, results in reduced sympathetic outflow. These effects result in a decrease in vasomotor tone and heart rate.

Questions

López-Pousa S, Garre-Olmo J, de Gracia M, Ribot J, Calvó-Perxas L, Vilalta-Franch J. Development of a multidimensional measure of fibromyalgia symptomatology: The comprehensive rating scale for fibromyalgia symptomatology. J Psychosom Res. 2013 May. 74(5):384-92. [Medline].
Borchers AT, Gershwin ME. Fibromyalgia: A Critical and Comprehensive Review. Clin Rev Allergy Immunol. 2015 Oct. 49 (2):100-51. [Medline].
Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum. 2007 Jun. 36(6):339-56. [Medline].
Sawaddiruk P, Paiboonworachat S, Chattipakorn N, Chattipakorn SC. Alterations of brain activity in fibromyalgia patients. J Clin Neurosci. 2017 Apr. 38:13-22. [Medline].
Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum. 2002 May. 46(5):1333-43. [Medline].
Wolfe F, Cathey MA, Kleinheksel SM. Fibrositis (Fibromyalgia) in rheumatoid arthritis. J Rheumatol. 1984 Dec. 11(6):814-8. [Medline].
Buskila D, Press J, Abu-Shakra M. Fibromyalgia in systemic lupus erythematosus: prevalence and clinical implications. Clin Rev Allergy Immunol. 2003 Aug. 25(1):25-8. [Medline].
Thompson ME, Barkhuizen A. Fibromyalgia, hepatitis C infection, and the cytokine connection. Curr Pain Headache Rep. 2003 Oct. 7(5):342-7. [Medline].
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 Feb. 33(2):160-72. [Medline].
Katz RS, Wolfe F, Michaud K. Fibromyalgia diagnosis: a comparison of clinical, survey, and American College of Rheumatology criteria. Arthritis Rheum. 2006 Jan. 54(1):169-76. [Medline].
Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010 May. 62(5):600-10. [Medline].
Observations with cases illustrative of a new, simple, and expeditious mode of curing rheumatism and sprains. Balfour W. J Lond Med Phys. 1824. 51:446-62.
Beard G. Neurasthenia, or nervous exhaustion. J Boston Med Surg. 1869. 80:217-22.
Gowers WR. Lumbago: Its lessons and analogues. Br Med J. 1904. 1:117-21.
Chaitow L. Fibromyalgia and Muscle Pain. Thorsons Pub; 1995. 1-205.
Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum. 1981 Aug. 11(1):151-71. [Medline].
Schmidt-Wilcke T, Diers M. New Insights into the Pathophysiology and Treatment of Fibromyalgia. Biomedicines. 2017 May 13. 5 (2):[Medline]. [Full Text].
Clauw DJ. Fibromyalgia: more than just a musculoskeletal disease. Am Fam Physician. 1995 Sep 1. 52(3):843-51, 853-4. [Medline].
Merskey H. Classification of chronic pain: Description of chronic pain syndromes and definitions of pain terms. Pain. 1986. Suppl 3:S217.
Pillemer SR, Bradley LA, Crofford LJ, Moldofsky H, Chrousos GP. The neuroscience and endocrinology of fibromyalgia. Arthritis Rheum. 1997 Nov. 40(11):1928-39. [Medline].
Crofford LJ. The hypothalamic-pituitary-adrenal stress axis in fibromyalgia and chronic fatigue syndrome. Z Rheumatol. 1998. 57 Suppl 2:67-71. [Medline].
Martinez-Lavin M. Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther. 2007. 9(4):216. [Medline].
Tanriverdi F, Karaca Z, Unluhizarci K, et al. The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome. Stress. 2007 Mar. 10(1):13-25. [Medline].
van Middendorp H, Lumley MA, Jacobs JW, Bijlsma JW, Geenen R. The effects of anger and sadness on clinical pain reports and experimentally-induced pain thresholds in women with and without fibromyalgia. Arthritis Care Res (Hoboken). 2010 Oct. 62(10):1370-6. [Medline].
Jones KD, Deodhar P, Lorentzen A, Bennett RM, Deodhar AA. Growth hormone perturbations in fibromyalgia: a review. Semin Arthritis Rheum. 2007 Jun. 36(6):357-79. [Medline].
Umeda M, Corbin LW, Maluf KS. Preliminary investigation of absent nociceptive flexion reflex responses among more symptomatic women with fibromyalgia syndrome. Rheumatol Int. 2013 Apr 4. [Medline].
Clauw DJ. Fibromyalgia: update on mechanisms and management. J Clin Rheumatol. 2007 Apr. 13(2):102-9. [Medline].
Staud R, Robinson ME, Vierck CJ Jr, et al. Diffuse noxious inhibitory controls (DNIC) attenuate temporal summation of second pain in normal males but not in normal females or fibromyalgia patients. Pain. 2003 Jan. 101(1-2):167-74. [Medline].
Staud R, Spaeth M. Psychophysical and neurochemical abnormalities of pain processing in fibromyalgia. CNS Spectr. 2008 Mar. 13(3 Suppl 5):12-7. [Medline].
Wood PB, Schweinhardt P, Jaeger E, et al. Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci. 2007 Jun. 25(12):3576-82. [Medline].
Sarchielli P, Di Filippo M, Nardi K, Calabresi P. Sensitization, glutamate, and the link between migraine and fibromyalgia. Curr Pain Headache Rep. 2007 Oct. 11(5):343-51. [Medline].
Diatchenko L, Slade GD, Nackley AG, et al. Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet. 2005 Jan 1. 14(1):135-43. [Medline].
Docampo E, Escaramís G, Gratacòs M, Villatoro S, Puig A, Kogevinas M, et al. Genome-wide analysis of single nucleotide polymorphisms and copy number variants in fibromyalgia suggest a role for the central nervous system. Pain. 2014 Jun. 155 (6):1102-9. [Medline].
Clauw DJ. Pharmacotherapy for patients with fibromyalgia. J Clin Psychiatry. 2008. 69 Suppl 2:25-9. [Medline].
Winfield JB. Psychological determinants of fibromyalgia and related syndromes. Curr Rev Pain. 2000. 4(4):276-86. [Medline].
Tander B, Gunes S, Boke O, et al. Polymorphisms of the serotonin-2A receptor and catechol-O-methyltransferase genes: a study on fibromyalgia susceptibility. Rheumatol Int. 2008 May. 28(7):685-91. [Medline].
Russell IJ, Orr MD, Littman B, et al. Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum. 1994 Nov. 37(11):1593-601. [Medline].
Griep EN, Boersma JW, de Kloet ER. Altered reactivity of the hypothalamic-pituitary-adrenal axis in the primary fibromyalgia syndrome. J Rheumatol. 1993 Mar. 20(3):469-74. [Medline].
Crofford LJ. Neuroendocrine aspects of fibromyalgia. J Musculoskelet Pain. 1994. 2:125-33.
Cuatrecasas G, Riudavets C, Güell MA, Nadal A. Growth hormone as concomitant treatment in severe fibromyalgia associated with low IGF-1 serum levels. A pilot study. BMC Musculoskelet Disord. 2007 Nov 30. 8:119. [Medline]. [Full Text].
Albrecht DS, Forsberg A, Sandström A, Bergan C, Kadetoff D, Protsenko E, et al. Brain glial activation in fibromyalgia - A multi-site positron emission tomography investigation. Brain Behav Immun. 2018 Sep 14. [Medline]. [Full Text].
Frellick M. Brain Inflammation Seen for First Time in Fibromyalgia. Medscape Medical News. Available at https://www.medscape.com/viewarticle/904827. November 13, 2018; Accessed: November 14, 2018.
Glass JM. Fibromyalgia and cognition. J Clin Psychiatry. 2008. 69 Suppl 2:20-4. [Medline].
Glass JM, Williams DA, Fernandez-Sanchez ML, Kairys A, Barjola P, Heitzeg MM, et al. Executive function in chronic pain patients and healthy controls: different cortical activation during response inhibition in fibromyalgia. J Pain. 2011 Dec. 12(12):1219-29. [Medline].
Lue FA. Sleep and fibromyalgia. J Musculoskelet Pain. 1994. 2:89-100.
WebSciences International and Sleep Research Society (United States). Basics of Sleep Behavior. Sleep Research Society. Available at http://www.sleepsources.org/uploads/sleepsyllabus/. 1997; Accessed: September 5, 2018.
Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8. 196(4286):129-36. [Medline].
Arnold LM, Hudson JI, Hess EV, Ware AE, Fritz DA, Auchenbach MB, et al. Family study of fibromyalgia. Arthritis Rheum. 2004 Mar. 50(3):944-52. [Medline].
Olson J. Mapping Genes for Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases; Aug 2004. Spotlight on Research, Fibromyalgia: Summaries of Research. [Full Text].
Diatchenko L, Nackley AG, Slade GD, et al. Idiopathic pain disorders--pathways of vulnerability. Pain. 2006 Aug. 123(3):226-30. [Medline].
Buskila D, Sarzi-Puttini P. Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome. Arthritis Res Ther. Jul 28 2006. 8(5):218.
Offenbaecher M, Bondy B, de Jonge S, Glatzeder K, Krüger M, Schoeps P, et al. Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region. Arthritis Rheum. 1999 Nov. 42(11):2482-8. [Medline].
Diatchenko L, Nackley AG, Slade GD, Bhalang K, Belfer I, Max MB, et al. Catechol-O-methyltransferase gene polymorphisms are associated with multiple pain-evoking stimuli. Pain. 2006 Dec 5. 125(3):216-24. [Medline].
Fillingim RB, Maixner W. Gender differences in the responses to noxious stimuli. Pain Forum. 1995. 4:209-221.
Moldofsky H, Scarisbrick P, England R, et al. Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects. Psychosom Med. 1975 Jul-Aug. 37(4):341-51. [Medline].
Schrader H, Obelieniene D, Bovim G, Surkiene D, Mickeviciene D, Miseviciene I, et al. Natural evolution of late whiplash syndrome outside the medicolegal context. Lancet. 1996 May 4. 347(9010):1207-11. [Medline].
Buskila D, Neumann L, Vaisberg G, Alkalay D, Wolfe F. Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury. Arthritis Rheum. 1997 Mar. 40(3):446-52. [Medline].
Obelieniene D, Schrader H, Bovim G, Miseviciene I, Sand T. Pain after whiplash: a prospective controlled inception cohort study. J Neurol Neurosurg Psychiatry. 1999 Mar. 66(3):279-83. [Medline].
Tishler M, Levy O, Maslakov I, Bar-Chaim S, Amit-Vazina M. Neck injury and fibromyalgia-- are they really associated?. J Rheumatol. 2006 Jun. 33(6):1183-5. [Medline].
Shir Y, Pereira JX, Fitzcharles MA. Whiplash and fibromyalgia: an ever-widening gap. J Rheumatol. 2006 Jun. 33(6):1045-7. [Medline].
Van Houdenhove B, Egle UT. Fibromyalgia: a stress disorder? Piecing the biopsychosocial puzzle together. Psychother Psychosom. 2004 Sep-Oct. 73(5):267-75. [Medline].
Van Houdenhove B, Luyten P. Beyond dualism: the role of life stress in chronic pain. Pain. 2005 Jan. 113(1-2):238-9; discussion 240-2. [Medline].
Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995 Jan. 38(1):19-28. [Medline].
Moldofsky H, Scarisbrick P. Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation. Psychosom Med. 1976 Jan-Feb. 38(1):35-44. [Medline].
Crombez G, Eccleston C, Van den Broeck A, et al. Hypervigilance to pain in fibromyalgia: the mediating role of pain intensity and catastrophic thinking about pain. Clin J Pain. 2004 Mar-Apr. 20(2):98-102. [Medline].
Keefe FJ, Lefebvre JC, Maixner W, Salley AN Jr, Caldwell DS. Self-efficacy for arthritis pain: relationship to perception of thermal laboratory pain stimuli. Arthritis Care Res. 1997 Jun. 10(3):177-84. [Medline].
Gracely RH, Geisser ME, Giesecke T, Grant MA, Petzke F, Williams DA, et al. Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain. 2004 Apr. 127:835-43. [Medline].
Bradley LA. Psychiatric comorbidity in fibromyalgia. Curr Pain Headache Rep. 2005 Apr. 9(2):79-86. [Medline].
Arnold LM, Hudson JI, Keck PE, Auchenbach MB, Javaras KN, Hess EV. Comorbidity of fibromyalgia and psychiatric disorders. J Clin Psychiatry. 2006 Aug. 67(8):1219-25. [Medline].
Giesecke T, Williams DA, Harris RE, Cupps TR, Tian X, Tian TX, et al. Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors. Arthritis Rheum. 2003 Oct. 48(10):2916-22. [Medline].
Giesecke T, Gracely RH, Williams DA, Geisser ME, Petzke FW, Clauw DJ. The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. Arthritis Rheum. 2005 May. 52(5):1577-84. [Medline].
Fassbender K, Samborsky W, Kellner M, Müller W, Lautenbacher S. Tender points, depressive and functional symptoms: comparison between fibromyalgia and major depression. Clin Rheumatol. 1997 Jan. 16(1):76-9. [Medline].
Hoffman DL, Dukes EM. The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12. Int J Clin Pract. 2008 Jan. 62(1):115-26. [Medline].
Hassett AL. Psychosocial aspects of fibromyalgia: psychological stress, psychiatric morbidity, and personality subgroups. 2008. pp 55-61.
McBeth J, Macfarlane GJ, Benjamin S, Morris S, Silman AJ. The association between tender points, psychological distress, and adverse childhood experiences: a community-based study. Arthritis Rheum. 1999 Jul. 42(7):1397-404. [Medline].
Buchwald D, Umali P, Umali J, Kith P, Pearlman T, Komaroff AL. Chronic fatigue and the chronic fatigue syndrome: prevalence in a Pacific Northwest health care system. Ann Intern Med. 1995 Jul 15. 123(2):81-8. [Medline].
Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJ, Wessely SC. Population based study of fatigue and psychological distress. BMJ. 1994 Mar 19. 308(6931):763-6. [Medline].
White LA, Birnbaum HG, Kaltenboeck A, et al. Employees with fibromyalgia: medical comorbidity, healthcare costs, and work loss. J Occup Environ Med. 2008 Jan. 50(1):13-24. [Medline].
Arnold LM, Crofford LJ, Mease PJ, et al. Patient perspectives on the impact of fibromyalgia. Patient Educ Couns. 2008 Oct. 73(1):114-20. [Medline]. [Full Text].
Vincent A, Lahr BD, Wolfe F, et al. Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project. Arthritis Care Res (Hoboken). 2013 May. 65(5):786-92. [Medline].
Branco JC, Bannwarth B, Failde I, et al. Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum. 2010 Jun. 39(6):448-53. [Medline].
Guermazi M, Ghroubi S, Sellami M, et al. [Fibromyalgia prevalence in Tunisia]. Tunis Med. 2008 Sep. 86(9):806-11. [Medline].
White KP, Speechley M, Harth M, Ostbye T. The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. J Rheumatol. 1999 Jul. 26(7):1570-6. [Medline].
Assumpção A, Cavalcante AB, Capela CE, et al. Prevalence of fibromyalgia in a low socioeconomic status population. BMC Musculoskelet Disord. 2009 Jun 8. 10:64. [Medline]. [Full Text].
Santos AM, Burti JS, Lopes JB, Scazufca M, Marques AP, Pereira RM. Prevalence of fibromyalgia and chronic widespread pain in community-dwelling elderly subjects living in São Paulo, Brazil. Maturitas. 2010 Nov. 67(3):251-5. [Medline].
Gansky SA, Plesh O. Widespread pain and fibromyalgia in a biracial cohort of young women. J Rheumatol. 2007 Apr. 34(4):810-7. [Medline].
Neumann L, Buskila D. Ethnocultural and educational differences in Israeli women correlate with pain perception in fibromyalgia. J Rheumatol. 1998 Jul. 25(7):1369-73. [Medline].
Felson DT. Comparing the prevalence of rheumatic diseases in China with the rest of the world. Arthritis Res Ther. 2008. 10(1):106. [Medline]. [Full Text].
Ferrari R, Russell AS. A questionnaire using the modified 2010 American College of Rheumatology criteria for fibromyalgia: specificity and sensitivity in clinical practice. J Rheumatol. 2013 Sep. 40(9):1590-5. [Medline].
Michels H, Gerhold K, Hafner R, et al. [Juvenile fibromyalgia syndrome]. Schmerz. 2008 Jun. 22(3):339-48. [Medline].
Palstam A, Bjersing JL, Mannerkorpi K. Which aspects of health differ between working and nonworking women with fibromyalgia? A cross-sectional study of work status and health. BMC Public Health. 2012 Dec 14. 12:1076. [Medline]. [Full Text].
Turk DC, Okifuji A, Sinclair JD, et al. Pain, disability, and physical functioning in subgroups of patients with fibromyalgia. J Rheumatol. 1996 Jul. 23(7):1255-62. [Medline].
Turk DC, Okifuji A, Sinclair JD, et al. Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment. Arthritis Care Res. 1998 Oct. 11(5):397-404. [Medline].
Dreyer L, Kendall S, Danneskiold-Samsoe B, Bartels EM, Bliddal H. Mortality in a cohort of Danish patients with fibromyalgia: increased frequency of suicide. Arthritis Rheum. 2010 Oct. 62(10):3101-8. [Medline].
Stephens RJ, Hopwood P, Girling DJ, Machin D. Randomized trials with quality of life endpoints: are doctors' ratings of patients' physical symptoms interchangeable with patients' self-ratings?. Qual Life Res. 1997 Apr. 6(3):225-36. [Medline].
Wolfe F, Clauw DJ, Fitzcharles MA, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011 Jun. 38(6):1113-22. [Medline].
Okifuji A, Turk DC, Sinclair JD, Starz TW, Marcus DA. A standardized manual tender point survey. I. Development and determination of a threshold point for the identification of positive tender points in fibromyalgia syndrome. J Rheumatol. 1997 Feb. 24(2):377-83. [Medline].
MacReady N. Test Excludes Fibromyalgia in Patients With Rheumatic Disease. Medscape Medical News. Available at http://www.medscape.com/viewarticle/865753. July 6, 2016; Accessed: October 7, 2017.
Fan A, Tournadre A, Pereira B, Tatar Z, Couderc M, Malochet-Guinamand S, et al. Performance of Fibromyalgia Rapid Screening Tool (FiRST) to detect fibromyalgia syndrome in rheumatic diseases. Rheumatology (Oxford). 2016 Jun 15. [Medline]. [Full Text].
Pincus T, Yazici Y, Bergman M. Development of a multi-dimensional health assessment questionnaire (MDHAQ) for the infrastructure of standard clinical care. Clin Exp Rheumatol. 2005 Sep-Oct. 23(5 Suppl 39):S19-28. [Medline].
[Guideline] Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choinière M, et al. 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Res Manag. 2013 May-Jun. 18 (3):119-26. [Medline]. [Full Text].
[Guideline] Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017 Feb. 76 (2):318-328. [Medline].
Wood PB. Treating comorbidities in fibromyalgia. Pain Pract. 2008. 18(1):pp 42-53.
Turk DC, Vierck CJ, Scarbrough E, et al. Fibromyalgia: combining pharmacological and nonpharmacological approaches to treating the person, not just the pain. J Pain. 2008 Feb. 9(2):99-104. [Medline].
Staud R. Treatment of fibromyalgia and its symptoms. Expert Opin Pharmacother. 2007 Aug. 8(11):1629-42. [Medline].
Sarzi-Puttini P, Buskila D, Carrabba M, et al. Treatment strategy in fibromyalgia syndrome: where are we now?. Semin Arthritis Rheum. 2008 Jun. 37(6):353-65. [Medline].
Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008 Apr. 67(4):536-41. [Medline].
Goldenberg DL. Pharmacological treatment of fibromyalgia and other chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2007 Jun. 21(3):499-511. [Medline].
Goldenberg DL. Multidisciplinary modalities in the treatment of fibromyalgia. J Clin Psychiatry. 2008. 69 Suppl 2:30-4. [Medline].
Burckhardt CS. Multidisciplinary approaches for management of fibromyalgia. Curr Pharm Des. 2006. 12(1):59-66. [Medline].
Häuser W, Bernardy K, Arnold B, Offenbächer M, Schiltenwolf M. Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Arthritis Rheum. 2009 Feb 15. 61(2):216-24. [Medline].
Benca RM, Ancoli-Israel S, Moldofsky H. Special considerations in insomnia diagnosis and management: depressed, elderly, and chronic pain populations. J Clin Psychiatry. 2004. 65 Suppl 8:26-35. [Medline].
Bigatti SM, Hernandez AM, Cronan TA, et al. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. 2008 Jul 15. 59(7):961-7. [Medline].
Moldofsky H. The significance, assessment, and management of nonrestorative sleep in fibromyalgia syndrome. CNS Spectr. 2008 Mar. 13(3 Suppl 5):22-6. [Medline].
Stephens S, Feldman BM, Bradley N, Schneiderman J, Wright V, Singh-Grewal D, et al. Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial. Arthritis Rheum. 2008 Oct 15. 59(10):1399-406. [Medline].
Kashikar-Zuck S, Cunningham N, Sil S, Bromberg MH, Lynch-Jordan AM, Strotman D, et al. Long-term outcomes of adolescents with juvenile-onset fibromyalgia in early adulthood. Pediatrics. 2014 Mar. 133(3):e592-600. [Medline].
Kelly J. Teenagers With Fibromyalgia Unlikely to 'Outgrow' the Pain. Medscape Medical News. Available at http://www.medscape.com/viewarticle/821275. Accessed: March 1, 2014.
Upadhyaya HP, Arnold LM, Alaka K, Qiao M, Williams D, Mehta R. Efficacy and safety of duloxetine versus placebo in adolescents with juvenile fibromyalgia: results from a randomized controlled trial. Pediatr Rheumatol Online J. 2019 May 28. 17 (1):27. [Medline]. [Full Text].
Thieme K, Flor H, Turk DC. Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments. Arthritis Res Ther. 2006. 8(4):R121. [Medline].
Thieme K, Turk DC, Flor H. Responder criteria for operant and cognitive-behavioral treatment of fibromyalgia syndrome. Arthritis Rheum. 2007 Jun 15. 57(5):830-6. [Medline].
Häuser W, Bernardy K, Uçeyler N, Sommer C. Treatment of fibromyalgia syndrome with antidepressants: a meta-analysis. JAMA. 2009 Jan 14. 301(2):198-209. [Medline].
Arnold LM, Sarzi-Puttini P, Arsenault P, Khan T, Bhadra Brown P, Clair A, et al. Efficacy and Safety of Pregabalin in Patients with Fibromyalgia and Comorbid Depression Taking Concurrent Antidepressant Medication: A Randomized, Placebo-controlled Study. J Rheumatol. 2015 Jul. 42 (7):1237-44. [Medline].
Jones KD, Adams D, Winters-Stone K, Burckhardt CS. A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988-2005). Health Qual Life Outcomes. 2006 Sep 25. 4:67. [Medline].
Busch AJ, Schachter CL, Overend TJ, et al. Exercise for fibromyalgia: a systematic review. J Rheumatol. 2008 Jun. 35(6):1130-44. [Medline].
Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008 Dec. 89(12):2250-7. [Medline].
Sawynok J, Lynch ME. Qigong and Fibromyalgia circa 2017. Medicines (Basel). 2017 Jun 6. 4 (2):[Medline]. [Full Text].
Wang C, Schmid CH, Fielding RA, Harvey WF, Reid KF, Price LL, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. 2018 Mar 21. 360:k851. [Medline]. [Full Text].
Living with Fibromyalgia, Drugs Approved to Manage Pain. U.S. Food and Drug Administration. Available at http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107802.htm#approved. January 31, 2014; Accessed: July 30, 216.
Lee YH, Song GG. Comparative efficacy and tolerability of duloxetine, pregabalin, and milnacipran for the treatment of fibromyalgia: a Bayesian network meta-analysis of randomized controlled trials. Rheumatol Int. 2016 May. 36 (5):663-72. [Medline].
Cuatrecasas G, Alegre C, Casanueva FF. GH/IGF1 axis disturbances in the fibromyalgia syndrome: is there a rationale for GH treatment?. Pituitary. 2013 Apr 9. [Medline].
Winfield JB. Pain and arthritis. N C Med J. 2007 Nov-Dec. 68(6):444-6. [Medline].
MacLean AJ, Schwartz TL. Tramadol for the treatment of fibromyalgia. Expert Rev Neurother. 2015 May. 15 (5):469-75. [Medline].
Peng X, Robinson RL, Mease P, Kroenke K, Williams DA, Chen Y, et al. Long-term evaluation of opioid treatment in fibromyalgia. Clin J Pain. 2015 Jan. 31 (1):7-13. [Medline].
Scharf MB, Hauck M, Stover R, et al. Effect of gamma-hydroxybutyrate on pain, fatigue, and the alpha sleep anomaly in patients with fibromyalgia. Preliminary report. J Rheumatol. 1998 Oct. 25(10):1986-90. [Medline].
Russell IJ, Perkins AT, Michalek JE. Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial. Arthritis Rheum. 2009 Jan. 60(1):299-309. [Medline].
Gendreau RM, Thorn MD, Gendreau JF, Kranzler JD, Ribeiro S, Gracely RH, et al. Efficacy of milnacipran in patients with fibromyalgia. J Rheumatol. 2005 Oct. 32(10):1975-85. [Medline].
Arnold LM, Rosen A, Pritchett YL, D'Souza DN, Goldstein DJ, Iyengar S, et al. A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder. Pain. 2005 Dec 15. 119(1-3):5-15. [Medline].
Arnold LM, Pritchett YL, D'Souza DN, Kajdasz DK, Iyengar S, Wernicke JF. Duloxetine for the treatment of fibromyalgia in women: pooled results from two randomized, placebo-controlled clinical trials. J Womens Health (Larchmt). 2007 Oct. 16(8):1145-56. [Medline].
Arnold LM. Duloxetine and other antidepressants in the treatment of patients with fibromyalgia. Pain Med. 2007 Sep. 8 Suppl 2:S63-74. [Medline].
Russell IJ, Mease PJ, Smith TR, Kajdasz DK, Wohlreich MM, Detke MJ, et al. Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain. 2008 Jun. 136(3):432-44. [Medline].
Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmid C. A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum. 1996 Nov. 39 (11):1852-9. [Medline].
Nelson LS, Erdman AR, Booze LL, Cobaugh DJ, Chyka PA, Woolf AD, et al. Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007 May. 45 (4):315-32. [Medline].
Besson JM, Chaouch A. Peripheral and spinal mechanisms of nociception. Physiol Rev. 1987 Jan. 67 (1):67-186. [Medline].
Colpaert FC, Tarayre JP, Koek W, Pauwels PJ, Bardin L, Xu XJ, et al. Large-amplitude 5-HT1A receptor activation: a new mechanism of profound, central analgesia. Neuropharmacology. 2002 Nov. 43 (6):945-58. [Medline].
Arnold LM, Goldenberg DL, Stanford SB, et al. Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial. Arthritis Rheum. 2007 Apr. 56(4):1336-44. [Medline].
Crofford LJ, Rowbotham MC, Mease PJ, Russell IJ, Dworkin RH, Corbin AE, et al. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2005 Apr. 52(4):1264-73. [Medline].
Crofford LJ, Mease PJ, Simpson SL, et al. Fibromyalgia relapse evaluation and efficacy for durability of meaningful relief (FREEDOM): a 6-month, double-blind, placebo-controlled trial with pregabalin. Pain. 2008 Jun. 136(3):419-31. [Medline].
Mease PJ, Farmer MV, Palmer RH, Gendreau RM, Trugman JM, Wang Y. Milnacipran combined with pregabalin in fibromyalgia: a randomized, open-label study evaluating the safety and efficacy of adding milnacipran in patients with incomplete response to pregabalin. Ther Adv Musculoskelet Dis. 2013 Jun. 5 (3):113-26. [Medline]. [Full Text].
Simpson DA. Gabapentin and venlafaxine for the treatment of painful diabetic neuropathy. J Clin Neuromuscul Dis. 2001 Dec. 3 (2):53-62. [Medline].
Sadreddini S, Molaeefard M, Noshad H, et al. Efficacy of Raloxifen in treatment of fibromyalgia in menopausal women. Eur J Intern Med. 2008 Jul. 19(5):350-5. [Medline].
Broughton RJ, Fleming JA, George CF, et al. Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of excessive daytime sleepiness in narcolepsy. Neurology. 1997 Aug. 49(2):444-51. [Medline].
Schwartz TL, Rayancha S, Rashid A, et al. Modafinil treatment for fatigue associated with fibromyalgia. J Clin Rheumatol. 2007 Feb. 13(1):52. [Medline].
Habib G, Artul S. Medical Cannabis for the Treatment of Fibromyalgia. J Clin Rheumatol. 2018 Aug. 24 (5):255-258. [Medline].
Skrabek RQ, Galimova L, Ethans K, et al. Nabilone for the treatment of pain in fibromyalgia. J Pain. 2008 Feb. 9(2):164-73. [Medline].
Rooks DS. Fibromyalgia treatment update. Curr Opin Rheumatol. 2007 Mar. 19(2):111-7. [Medline].
Bootzin RR, Lahmeyer HW, Lilie JK. Easy Steps to Help You Sleep. Chicago, Ill: Searle Pharmaceuticals; 1994. 1-34.
Choy EH. Current treatments to counter sleep dysfunction as a pathogenic stimulus of fibromyalgia. Pain Manag. 2016 May. 6 (4):339-46. [Medline].
Holman AJ, Myers RR. A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Arthritis Rheum. 2005 Aug. 52(8):2495-505. [Medline].
Logan AC. Is there a fibromyalgia diet. Fibromyalgia Aware. Dec 2004-Mar 2005. 8:46-9.
Sanada K, Díez MA, Valero MS, Pérez-Yus MC, Demarzo MM, García-Toro M, et al. Effects of non-pharmacological interventions on inflammatory biomarker expression in patients with fibromyalgia: a systematic review. Arthritis Res Ther. 2015 Sep 26. 17:272. [Medline]. [Full Text].
Ciappuccini R, Ansemant T, Maillefert JF, Tavernier C, Ornetti P. Aspartame-induced fibromyalgia, an unusual but curable cause of chronic pain. Clin Exp Rheumatol. 2010 Nov-Dec. 28 (6 Suppl 63):S131-3. [Medline].
Smith JD, Terpening CM, Schmidt SO, Gums JG. Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. Ann Pharmacother. 2001 Jun. 35 (6):702-6. [Medline].
Cairns BE. Influence of pro-algesic foods on chronic pain conditions. Expert Rev Neurother. 2016. 16 (4):415-23. [Medline].
Callahan LF, Freburger JK, Mielenz TJ, Wiley-Exley EK. Medical skepticism and the use of complementary and alternative health care providers by patients followed by rheumatologists. J Clin Rheumatol. 2008 Jun. 14(3):143-7. [Medline].
[Guideline] Yokota S, Kikuchi M, Miyamae T. Juvenile fibromyalgia: Guidance for management. Pediatr Int. 2013 Aug. 55 (4):403-9. [Medline].
[Guideline] Draheim N, Ebinger F, Schnöbel-Müller E, Wolf B, Häuser W. [Definition, diagnostics and therapy of chronic widespread pain and the (so-called) fibromyalgia syndrome in children and adolescents : Updated guidelines 2017]. Schmerz. 2017 Jun. 31 (3):296-307. [Medline].
[Guideline] Sommer C, Alten R, Bär KJ, Bernateck M, Brückle W, Friedel E, et al. [Drug therapy of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles]. Schmerz. 2017 Jun. 31 (3):274-284. [Medline].
[Guideline] Schiltenwolf M, Eidmann U, Köllner V, Kühn T, Offenbächer M, Petzke F, et al. [Multimodal therapy of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles]. Schmerz. 2017 Jun. 31 (3):285-288. [Medline].
[Guideline] Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choinière M, et al. Canadian Pain Society and Canadian Rheumatology Association recommendations for rational care of persons with fibromyalgia: a summary report. J Rheumatol. 2013 Aug. 40 (8):1388-93. [Medline].
[Guideline] Petzke F, Brückle W, Eidmann U, Heldmann P, Köllner V, Kühn T, et al. [General treatment principles, coordination of care and patient education in fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles]. Schmerz. 2017 Jun. 31 (3):246-254. [Medline].
[Guideline] Ablin JN, Amital H, Ahrenfeld M, et al. Guidelines for the diagnosis and treatment of the fibromyalgia syndrome (Hebrew). Harefuah. Available at http://www.ima.org.il/Ima/FormStorage/ Type7/clinical 68 fibrom.pdf . 2013; Accessed: November 2, 2017.
Arnold LM, Russell IJ, Diri EW, Duan WR, Young JP Jr, Sharma U, et al. A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia. J Pain. 2008 Sep. 9(9):792-805. [Medline].

Media Gallery

A neurophysiologist's view of pain. Courtesy of Alan R. Light, PhD.
Tender points in fibromyalgia.
Pressure algometer (dolorimeter).
Biopsychosocial model of fibromyalgia.

of 4

Author

Chad S Boomershine, MD, PhD, CPI, CPT Assistant Clinical Professor, Department of Medicine, Vanderbilt University School of Medicine; Principal Investigator, Clinical Research Solutions; Medical Director, Boomershine Wellness Centers, Elite Healthcare Alliance, Platinum Medical Group, and Spectrum Pain Clinic

Chad S Boomershine, MD, PhD, CPI, CPT is a member of the following medical societies: American College of Rheumatology, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Pfizer;<br/>Serve(d) as a speaker or a member of a speakers bureau for: Pfizer;.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, and American College of Rheumatology

Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; UCB Speaking and teaching; Omnicare Consulting fee Consulting; Centocor Consulting fee Consulting

Kristine M Lohr, MD, MS Professor, Department of Internal Medicine, Center for the Advancement of Women's Health and Division of Rheumatology, Director, Rheumatology Training Program, University of Kentucky College of Medicine

Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

John Buckner Winfield, MD Herman and Louise Smith Distinguished Professor of Medicine in Arthritis Emeritus, Department of Medicine, Senior Member, Neurosensory Disorders Center, University of North Carolina at Chapel Hill; Consulting Rheumatologist, Appalachian Regional Rheumatology

John Buckner Winfield, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Immunologists, American Clinical and Climatological Association, American College of Rheumatology, American Federation for Clinical Research, American Pain Society, American Society for Clinical Investigation, Association of American Physicians, and North Carolina Medical Society

Disclosure: Pfizer Honoraria Speaking and teaching; Forest Honoraria Speaking and teaching

Fibromyalgia Medication

Medication Summary

Analgesics

Class Summary

Tramadol (Ultram, Ryzolt, Rybix)

Antianxiety Agents

Class Summary

Alprazolam (Xanax, Niravam)

Clonazepam (Klonopin)

Zolpidem (Ambien)

Zaleplon (Sonata)

Trazodone (Oleptro)

Buspirone

Temazepam (Restoril)

Sodium Oxybate (Xyrem)

Skeletal Muscle Relaxants

Class Summary

Cyclobenzaprine (Flexeril, Flexmid)

Antidepressants

Class Summary

Amitriptyline

Duloxetine (Cymbalta)

Milnacipran (Savella)

Venlafaxine (Effexor, Effexor XR)

Desvenlafaxine (Pristiq)

Levomilnacipran (Fetzima)

Anticonvulsants

Class Summary

Pregabalin (Lyrica)

Gabapentin (Neurontin)

Tiagabine (Gabitril)

Alpha2 Agonists

Class Summary

Clonidine (Catapres, Kapvay)

References

Tables

Contributor Information and Disclosures

What would you like to print?

Find Us On

About

Membership

WebMD Network

Editions