From: Biology and therapy of fibromyalgia. New therapies in fibromyalgia
1. | Serotonin and norepinephrine reuptake inhibitors improve pain, other symptom domains, function, quality of life, and global well-being in patients with fibromyalgia. |
2. | Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) offer an alternative to cyclic medications (e.g., tricyclics) that are associated with safety and tolerability concerns. |
3. | The effect of SNRIs on reduction in pain associated with fibromyalgia is independent of their effects on mood. |
4. | Alpha 2 delta ligands also improve pain, other symptom domains, function, and global well-being in patients with fibromyalgia. |
5. | Alpha 2 delta ligands improve slow wave sleep. |
6. | Drugs associated with high risk of abuse and dependence should be avoided. Opiates may contribute to hyperalgesia if used chronically. |
7. | Although studies are limited, combinations of medications (e.g., combination of an SNRI and alpha 2 delta ligand) may be an option for patients who do not fully respond to a single agent or who have problems with tolerability at higher doses. |