- Last Updated: 03 January 2016 03 January 2016
Fibromyalgia (FM) has received a lot more attention over the last couple of years through television and magazine advertisements promoting three new drugs indicated for use in FM. Lyrica (pregabalin), Cymbalta (duloxetine), and Savella (milnacipran) were approved by the Food Drug Administration (FDA) as effective treatments for FM based on their performance in clinical trials.
In order to meet the FDA criteria as "effective" treatments, these drugs had to show benefits or some measurable level of improvement in study participants as they compared to placebos (substances with no active ingredients) in each their own trials. These medications might provide considerable relief for some patients, but they do not work the same way for everyone with FM, for a number of reasons.
These particular drugs differ from each other in their chemical composition and modes of action (i.e., they target different brain chemicals). Therefore, how each patient responds to any one of these will greatly depend on his or her own body chemistry, variation in symptoms, and severity of illness. The majority of FM patients have pain and disrupted sleep, but some may find mood disturbances to be problematic, while others have digestive, intestinal or bowel sensitivities. It is not unusual for FM patients to be prescribed multiple medications, to manage multiple symptoms, which may put some patients at a greater risk of adverse drug interactions.
Whenever new treatments are being contemplated, the general rule is to select a drug where its benefits are thought to outweigh the potential risks, and anything else known about the patient's medical history that might negatively impact him or her. In addition, when starting out any new medication, it is usually recommended that individuals with FM begin with a very low dose (i.e. 25% of prescribed dose) and work their way up slowly to the full prescribed dose, watching for any adverse side effects. This particularly applies to these drugs.
Despite their limited "track records" there often tends to be an eagerness to try out the latest treatments. Decisions to initiate treatment are often based on favorable study results (i.e., the acceptance of study results at face value) and may not take into account other factors that influenced results (i.e., the severity of illness in the study participants or the placebo effect that produced favorable response). The result is the possibility of unrealistic expectations for the typical FM patient, who may have a more complicated history or combination of problems than study participants.
A group of German doctors conducted an extensive review of these three drugs on their overall efficacy, benefits and adverse effects, with one significant difference—they evaluated how they measured up to each other. Their comparative analysis was published in 2010 in the Journal of Pain, the official scientific journal of the American Pain Society. Their findings and excerpts from several other studies are examined later in this article. But first, we will review the basic properties of these medications and the developments since their release on the market.
Notice about names
The Massachusetts ME/CFS & FM Association would like to clarify the use of the various acronyms for Chronic Fatigue Syndrome (CFS), Chronic Fatigue & Immune Dysfunction Syndrome (CFIDS) and Myalgic Encephalomyelitis (ME) on this site. When we generate our own articles on the illness, we will refer to it as ME/CFS, the term now generally used in the United States. When we are reporting on someone else’s report, we will use the term they use. The National Institutes of Health (NIH) and other federal agencies, including the CDC, are currently using ME/CFS.
Massachusetts ME/CFS & FM Association changed its name in July, 2018, to reflect this consensus.