Pharmacological treatment of fibromyalgia and other chronic musculoskeletal pain

The pharmacologic management of fibromyalgia is based on the emerging evidence that pain in this disorder is primarily related to central pain sensitization. There is strong evidence that tricyclic antidepressants are effective, and moderate evidence for the effectiveness of serotonin reuptake inhibitors and dual serotonin–norepinephrine reuptake inhibitors. Recent work suggests that the anti-seizure medications pregabalin and gabepentin are also effective. The only analgesic demonstrated to be helpful is tramadol.

Key words: pharmacologic management of fibromyalgia, central pain sensitization, tricyclic antidepressants, serotonin reuptake inhibitors, dual serotonin–norepinephrine reuptake inhibitors, anti-seizure medications, tramadol