Treatment of Fibromyalgia in Severe Fibromyalgia Pain
Fibromyalgia presenting with severe pain represents a distinct clinical situation in which pharmacological intervention is specifically indicated by evidence-based guidelines. The therapeutic goal is a clinically meaningful reduction in pain.
This protocol targets patients with fibromyalgia who are experiencing severe pain. Pain severity at this level is a recognised threshold for considering pharmacological therapy, distinct from mild-to-moderate presentations where non-pharmacological strategies alone may suffice.
Pharmacological therapies from several drug classes have demonstrated efficacy in this population and may be considered as part of the management plan. The specific agents, sequencing, and treatment duration are detailed in the structured protocol.
Treatment goal:
≥30% reduction in fibromyalgia pain
References
DOI: 10.1136/annrheumdis-2016-209724
- Pharmacological therapies (all 'weak for') should be considered for those with severe pain (duloxetine, pregabalin, tramadol) or sleep disturbance (amitriptyline, cyclobenzaprine, pregabalin).
- A recent Cochrane review reported patients receiving active treatment were more likely to have 30% pain reduction, RR 1.37, 95% CI 1.22 to 1.53, with a 'number needed to benefit' (NNTB) over placebo of 9, 95% CI 7 to 13.
- Those in the active arm were more likely to have 30% improvement in pain (RR 1.77, 95% CI 1.26 to 2.48).