Treatment Options

There are a wide variety of medications being used to treat the pain and other elements of FMS. The three medications that have approval from the U.S. Food and Drug Administration for treating fibromyalgia pain are:

■ pregabalin (Lyrica)—150—225 mg twice per day

■ milnacipran (Savella)—50 mg twice a day (Mease et al., 2009)

The action of pregabalin, an anticonvulsant medication, is to bind to the alpha-2-delta subunit on a neuron with the resulting limitation of calcium influx, decreasing neuronal activity. It also affects the production of pain facilitators, substance P, and glutamate (Mease et al., 2009).

Duloxetine, an antidepressant medication, is a serotonin norepi-nephrine reuptake inhibitor. It works on the inhibitory pathway and modulates pain by allowing an increase in the available serotonin and norepinephrine (Mease et al., 2009).

Milnacipran, an antidepressant-type medication, has a selective serotonin reuptake inhibitor action. It also has a limited NMDA inhibition component (Mease et al., 2009.)

Each of the medications are started at lower doses and titrated up to the effective or maximum dose. The side effects of all of these medications are dose related. If the patient reports sedation, nausea, or dizziness, reducing the dose and titrating more slowly will facilitate tolerance of the medication. For mild sedation, the patients may need to take the medication at bedtime, rather than in the morning or during the day.

Other medications used to treat fibromyalgia that have evidence of efficacy are as follows:

■ amitriptyline (Elavil) 25—50 mg/day—not recommended for older patients because of the potential for hypotension

■ cyclobenzaprine (Flexeril) 10—30 mg/day at bedtime

■ venlafaxine (Effexor) 37.5-300 mg/day (APS, 2005)

Other medications/drugs that show weak evidence for efficacy are as follows.

■ S-adenosyl-methionine

■ 5-hydroxytrptamine

Other medications/drugs that show no evidence for efficacy are as follows:

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