Pharmacotherapy (Drug Based Treatments)
There are some drugs that have been approved for use in the United States, such as; milnacipran, duloxetine, and pregabalin.
Antidepressants
They are the most used for the treatment of FM. These drugs work in FM patients with or without depression, because antidepressants raise the levels of some chemicals in the brain that are involved in modulating pain [2] (including serotonin and norepinephrine) that are associated with depression, pain and fatigue. There are several types of antidepressants:
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Tricyclic antidepressants: taken at night at lower doses than when prescribed for depression. They improve sleep and they can also relax muscles and improve pain, by increasing the action of endorphins (natural substances that are secreted by the body and used to control pain).
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Selective serotonin reception inhibitors: they are sometimes used when tricyclic antidepressants fail. They promote the release of serotonin, reduce fatigue and other symptoms of FM.
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Serotonin and Norepinephrine Reception Inhibitors (Dual Action Antidepressants): They increase the concentrations of serotonin and norepinephrine. They seem to improve pain more than selective serotonin reuptake inhibitor antidepressants, probably because increasing norepinephrine levels have a greater analgesic effect.
Many patients question the reason for using these drugs, especially antidepressants. If they are not properly clarified, doubts may arise about the origin of their symptoms. Therefore, when used, the rheumatologist must clarify that these drugs will act on the mechanisms involved in the generation and inhibition of pain and other symptoms of the disease, regardless of influencing the patient’s mood.
Despite the fact that many chronic pain syndromes, including fibromyalgia, are accompanied by depression, some studies have shown that the analgesic activity of antidepressants does not depend on their effect on the emotional status of patients.
A recent meta-analysis [3] of 18 Randomized Control Trails confirms that antidepressants can reduce pain in fibromyalgia, reduce depression, fatigue, restore sleep and improve quality of life