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Table 5 Food and Drug Administration-approved pharmacological strategies

From: Beyond pain in fibromyalgia: insights into the symptom of fatigue

Intervention Design and sample Scales used Mechanism of action Effect on fatigue
Duloxetine 3 double blind, placebo-controlled RCTs of patients with FM (n = 899) [8890] MFI Blocks reuptake of serotonin and norepinephrine within the central nervous system Clinically meaningful improvement in 2 of the RCTs, no clinically meaningful improvement in the other
FIQ fatigue
Milnacipran 6 double-blind, placebo-controlled RCTs of patients with FM (n = 4,243) [9196] MFI Blocks reuptake of serotonin and norepinephrine within the central nervous system No clinically meaningful improvement in 4 RCTs using MFI, cannot draw conclusion in 2 RCTs, and clinically meaningful improvement in 1 RCT (VAS fatigue)
1 double-blind, dose finding trial (n = 468) [97] VAS fatigue
Pregabalin 3 double-blind, placebo-controlled RCTs of patients with FM (n = 2,328) [98100] MAF Interacts with the alpha-2-delta subunit of l-type voltage-regulated calcium channels No clinically meaningful improvement in 2 RCTs, cannot draw conclusion in 1 RCT
  1. FIQ, Fibromyalgia Impact Questionnaire; FM, fibromyalgia; MAF, Multidimensional Assessment of Fatigue; MFI, Multidimensional Fatigue Inventory; RCT, randomized controlled trial; VAS, Visual Analogue Scale.