Medications & Treatments
Fibromyalgia treatment is multidisciplinary — no single approach works for everyone. The most effective strategies combine pharmacological and non-pharmacological interventions.
FDA-Approved Medications
💊 SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
- **Duloxetine (Cymbalta)** — 60–120 mg/day. Reduces pain, fatigue, and improves mood. A 2026 cost-effectiveness analysis (Markov model, *JAMA Network Open*) found the 120 mg dose delivered better value over time than pregabalin or amitriptyline for many patients — a useful data point to discuss with your prescriber, not a reason to self-adjust dosing
- **Milnacipran (Savella)** — 100–200 mg/day. Reduces pain and fatigue
💊 Anticonvulsants
- **Pregabalin (Lyrica)** — 150–600 mg/day. Reduces pain and improves sleep. Common side effects: dizziness, drowsiness
Other Pharmacological Options
- Low-dose tricyclics (amitriptyline, nortriptyline) — improve sleep, mild pain relief
- Tramadol — short-term use for severe flares
- Medical cannabis — mixed evidence; legal status varies
- Tropisetron — 5-HT3 antagonist showing promise in some studies
Non-Pharmacological Treatments (Strong Evidence)
🧠 Cognitive Behavioral Therapy (CBT)
The strongest evidence base for non-drug treatment. Helps patients develop coping strategies, manage pain catastrophizing, and improve sleep habits.
🏃 Exercise Therapy
Graded aerobic exercise, resistance training, yoga, tai chi, and aquatic therapy all show significant benefit. See the Exercise & Movement article for details.
🤲 Acupuncture
Supported by multiple RCTs and meta-analyses. May work through modulation of central pain pathways.
🌿 Traditional Chinese Medicine (TCM)
Herbal preparations, medicinal paste, and acupuncture are widely used in China. Network meta-analyses show herbal medicine combined with conventional therapy outperforms conventional therapy alone.
What About Opioids?
Opioids are not recommended for fibromyalgia. They carry significant risks (dependence, hyperalgesia) and show limited long-term benefit. Major guidelines including EULAR explicitly advise against routine opioid use.
Work with your healthcare team. The best treatment plan is individualized, combining approaches that work for your specific symptoms and circumstances.