Patient-friendly summary
If you read nothing else
Bottom line
Pregabalin, duloxetine, and milnacipran are the pharmacological treatments best supported by evidence for fibromyalgia pain, but the mood and cognitive aspects remain under-researched.
Moderate evidencePublished
Evidence hierarchy
Study participants
Patients with fibromyalgia studied in the reviewed pharmacological literature
Study Summary
This conference-abstract literature review examined the level of evidence supporting pharmacological treatment of fibromyalgia, a chronic condition with high psychiatric comorbidity and incompletely understood pathogenesis. Searching the main medical databases for papers published between January 2000 and August 2020, the author found that interest in fibromyalgia treatment has grown over the last decade, with the number of clinical trials nearly doubling versus the previous decade. Pregabalin, duloxetine, and milnacipran emerged as the agents best supported by evidence, particularly for the pain component, while amitriptyline, gabapentin, cyclobenzaprine, and tramadol have been studied but with weaker supporting evidence. The cognitive, sleep, and mood dimensions of fibromyalgia remain far less investigated, so no clear medication recommendation could be made for those domains.
Key Findings
| Finding | Detail | Impact |
|---|---|---|
| Pregabalin, duloxetine, and milnacipran are best supported by evidence | The review identifies pregabalin (a gabapentinoid), duloxetine, and milnacipran (serotonin-norepinephrine reuptake inhibitors) as the pharmacological treatments most supported by evidence for fibromyalgia, especially for the pain component. | High |
| Other agents have weaker supporting evidence | Amitriptyline, gabapentin, cyclobenzaprine, and tramadol have also been studied in various clinical trials, but there is less evidence to support their use. | Medium |
| Non-pain dimensions are under-investigated | Cognitive dysfunction, sleep disorders, and mood disturbances have received far less investigation in clinical trials, so no clear recommendation can be made about the superiority of one agent over another for these domains. | Medium |
| Growing research interest in fibromyalgia treatment | Interest in treating fibromyalgia has increased over the last decade, with the number of clinical trials for this indication almost doubling compared with the previous decade. | Low |
The review identifies pregabalin (a gabapentinoid), duloxetine, and milnacipran (serotonin-norepinephrine reuptake inhibitors) as the pharmacological treatments most supported by evidence for fibromyalgia, especially for the pain component.
Amitriptyline, gabapentin, cyclobenzaprine, and tramadol have also been studied in various clinical trials, but there is less evidence to support their use.
Cognitive dysfunction, sleep disorders, and mood disturbances have received far less investigation in clinical trials, so no clear recommendation can be made about the superiority of one agent over another for these domains.
Interest in treating fibromyalgia has increased over the last decade, with the number of clinical trials for this indication almost doubling compared with the previous decade.
Strengths
- Covers a broad 20-year window (2000-2020) across the main medical databases
- Distinguishes between drugs with stronger versus weaker evidence
- Explicitly highlights the under-researched mood, sleep, and cognitive dimensions of fibromyalgia
Limitations
- Published only as a brief conference abstract (E-poster), so methods and full results are not detailed
- Number of included studies and formal selection/quality-appraisal criteria are not reported
- Narrative review by a single author, with no quantitative synthesis or effect sizes provided
- Search paradigm focused on antidepressants, mood stabilizers, and anxiolytics, which may not capture all relevant pharmacological classes
Key Takeaways for Patients
What This Means for You
- 01For fibromyalgia pain, the medications with the strongest research support are pregabalin, duloxetine, and milnacipran.
- 02Other medicines such as amitriptyline, gabapentin, cyclobenzaprine, and tramadol have been studied but have weaker evidence behind them.
- 03There is currently far less research on which medications best help the cognitive ('fibro fog'), sleep, and mood problems that often come with fibromyalgia.
- 04Fibromyalgia often occurs alongside psychiatric conditions, so treatment usually needs to address more than pain alone — discuss the full picture with your doctor.