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The diversity of patients diagnosed with fibromyalgia means that treatment is always carried out individually depending on the severity and consequences of each patient’s symptoms.
The current foundations for fibromyalgia treatment are drug therapy combined with physical exercise and cognitive behavioural therapy.
Treatment is usually multidisciplinary and combines drug therapies, interventional procedures, psychologists, physical therapists (physiotherapy) and functional therapists (occupational therapy). This combination of treatments has proven to be the most effective therapy to date.
There are several evidenced-based guidelines covering the treatment of fibromyalgia: the European League Against Rheumatism (EULAR), American Pain Society (APS), Spanish Society of Rheumatology (SER) and the 2010 multidisciplinary group formed from various scientific societies.
The pain can affect quality of sleep, while at the same time, sleep abnormalities can aggravate the pain. Too much daytime rest can reduce the feeling of waking up refreshed. It is important to sleep well, but it is not essential for maintaining an adequate level of activity. To improve the quality of sleep, patients must establish a suitable routine and increase their activity levels.
The medications that have proven most effective are:
Tricyclic antidepressants, e.g., amitriptyline and cyclobenzaprine.
Serotonin and norepinephrine reuptake inhibitors, e.g., duloxetine and milnacipran.
Gabapentinoids, e.g., pregabalin.
Certain analgesics, e.g., tramadol.
It is hard to predict which treatment will be most effective. Sometimes a medication is initially effective, but it later stops working so well.
Controlled response tests are generally conducted after 2 and 6 weeks to determine which is the most effective medicine and establish a good drug treatment plan.
There are other drugs which have not demonstrated any efficacy in clinical trials: non-steroidal anti-inflammatories, major opioids (morphine, fentanyl, etc.), long-term anxiolytics, hormonal therapies and parapharmacy products (which may be counterproductive and whose effectiveness has not been scientifically proven).
Generally speaking, the medications used to treat fibromyalgia do not usually cause any severe side effects so long as the recommended dosages and guidelines are followed. However, patients can often experience dizziness, mental dulling, headaches, nausea, and so on, which they must be aware of and may sometimes find unbearable.
The complete withdrawal of medication during clinical trials due to patient intolerance is usually around 15%, although this value can be higher if there is insufficient information, an incorrect dosage, or them taking other medicines at the same time.