title: An update on pharmacotherapy for the treatment of fibromyalgia.
abstract: BACKGROUND
  Fibromyalgia is a syndrome characterized by chronic generalized pain in addition to different symptoms such as fatigue, sleep disturbances, stiffness, cognitive impairment, and psychological distress. Multidisciplinary treatment combining pharmacological and nonpharmacological therapies is advised.
  
  
  METHODS
  Publications describing randomized controlled trials and long-term extension studies evaluating drug treatment for fibromyalgia were searched in PubMed and Scopus and included in this review.
  
  
  CONCLUSIONS
  Different drugs are recommended for the treatment of fibromyalgia by different published guidelines, although only three of them have been approved for this indication by the US FDA, and none have been approved by the European Medicines Agency. According to the available evidence, pregabalin, duloxetine and milnacipran should be the drugs of choice for the treatment of this disease, followed by amitriptyline and cyclobenzaprine. Other drugs with at least one positive clinical trial include some selective serotonin reuptake inhibitors, moclobemide, pirlindole, gabapentin, tramadol, tropisetron, sodium oxybate and nabilone. None of the currently available drugs are fully effective against the whole spectrum of fibromyalgia symptoms, namely pain, fatigue, sleep disturbances and depression, among the most relevant symptoms. Combination therapy is an option that needs to be more thoroughly investigated in clinical trials.
authors.affiliation: Universidad de Granada, Instituto de Neurociencias , Granada, 18012 , Spain +0034 958246291 ; +0034 958246187 ; calandre@gmail.com.
authors.forename: Elena P
authors.initials: EP
authors.lastname: Calandre
authors.forename: Fernando
authors.initials: F
authors.lastname: Rico-Villademoros
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Slim
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D015507:Drugs, Investigational / Q000627:therapeutic use; D005356:Fibromyalgia / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000927:Anticonvulsants; D000928:Antidepressive Agents; D015507:Drugs, Investigational; D008996:Monoamine Oxidase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors
keywords: drug efficacy; drug tolerability; drug treatment; fibromyalgia; review