Fibromyalgia medicine and treatment options

Fibromyalgia is a chronic pain syndrome consisting of widespread musculoskeletal pain, thought to be neurologic in nature.

It is also associated with fatigue, problems with sleep, mood changes and difficulty focusing. Currently, the cause is unknown, but genetics is thought to play a role. There is no current cure for fibromyalgia. Therefore, treatment targets symptoms of the condition.

Fibromyalgia affects around 2% to 4% of the population and is more common in women. The typical age of onset is around 30–50 years of age. Many other conditions may have similar signs and symptoms, so it's important to see your primary healthcare provider to get a complete checkup if you are experiencing symptoms.

The American College of Rheumatology identifies criteria for a fibromyalgia diagnosis as:

1. Pain and symptoms over the past week, based on the total of number of painful areas out of 19 parts of the body, plus level of severity of these symptoms:
   • Fatigue 
   • Waking unrefreshed
   • Cognitive (memory or thought) problems
   Plus  a number of other general physical symptoms
   
   
2. Symptoms lasting at least three months at a similar level
   
   
3. No other health problem that would explain the pain and other symptoms

The pain associated with fibromyalgia is commonly described as burning, sore, achy or stiff. Symptoms are typically worsened in cold or humid temperatures, with poor sleep and when under physical or mental stress.

A healthy lifestyle is important when managing any chronic medical condition. You can help manage your fibromyalgia with the following:

• Healthy sleep patterns: Maintain a consistent sleep schedule free of distractions. Fibromyalgia symptoms are typically worsened with poor sleep. Avoidance of naps during the day and limiting caffeine intake can also help improve sleep.

• Exercise: Exercise lessens pain and fatigue associated with fibromyalgia. Achieving 150 minutes per week of moderate aerobic exercise, such as walking or swimming, as well as strength training with weights is recommended. Tai chi, yoga and qigong have also shown benefits in improvement of sleep long term.

• Cognitive behavioral therapy: Speaking to a therapist has long-term benefits in reduction of pain and disability in those with fibromyalgia. 

• Stress reduction: Stress can worsen fibromyalgia symptoms. Since stress reduction techniques vary from person to person, work with your provider if you need help managing stress.

Trying natural remedies is recommended before starting medication to manage fibromyalgia. The following can help to manage stress, pain and sleep problems:

• Acupuncture: reduces pain and fatigue

• Hydrotherapy/balneotherapy (types of water massage): improves pain long-term

• Mind-body therapy (meditation): reduces pain and stress

Natural remedies currently not recommended due to lack of compelling evidence for use in fibromyalgia include:

• Chiropractic manipulation

• Hypnotherapy (focus and concentration therapy)

• Essential oils

• Homeopathic therapy

Currently, there are three FDA-approved medications for the treatment of fibromyalgia symptoms: Lyrica (pregabalin), Cymbalta (duloxetine) and Savella (milnacipran). Medication is typically considered after the patient attempts lifestyle changes and natural remedies and is tailored to the individual needs of the patient. The following table outlines what you should know before considering these medications:

Additional pain relief:

• Tramadol taken with or without acetaminophen has been recommended for short-term relief of fibromyalgia pain. Long-term use is not recommended due to its risk for addiction.

• Opioids are not recommended for fibromyalgia

Additional sleep relief:

• Amitriptyline used at low doses has been shown to improve sleep patterns, as well as provide some pain relief in those with fibromyalgia

• Cyclobenzaprine has shown some benefit in helping those with fibromyalgia fall asleep more easily

Fibromyalgia treatment typically includes a combination of lifestyle modification, natural remedies and medication to find relief. No single treatment or combination of treatments works for every person the same way. Talk to your healthcare provider about your treatment options to find what works best for your personal goals and needs.

Clinically reviewed and updated by Nancy Kupka, PhD, RN, June 2022.