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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) [88–90]

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) [91–96]

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) [98–100]

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.