Serotonin and norepinephrine reuptake inhibitors improve pain, other symptom domains, function, quality of life, and global well-being in patients with fibromyalgia.
Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) offer an alternative to cyclic medications (e.g., tricyclics) that are associated with safety and tolerability concerns.
The effect of SNRIs on reduction in pain associated with fibromyalgia is independent of their effects on mood.
Alpha 2 delta ligands also improve pain, other symptom domains, function, and global well-being in patients with fibromyalgia.
Alpha 2 delta ligands improve slow wave sleep.
Drugs associated with high risk of abuse and dependence should be avoided. Opiates may contribute to hyperalgesia if used chronically.
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.