Current and Emerging Pharmacotherapy for Fibromyalgia

Table 1

Overview of effective pharmacological treatments for FM discussed in this review.

Drug	Mechanism	Effects on disease symptoms	Quality of evidence
Amitriptyline	Tricyclic antidepressant	Improvement in pain, fatigue, and sleep abnormalities.	Several randomized controlled trials, guideline recommended [8–10]
Duloxetine	Serotonin-noradrenaline reuptake inhibitor	Improvement in pain and depression.	Several randomized controlled trials, meta-analysis [11, 12]
Milnacipran	Serotonin-noradrenaline reuptake inhibitor	Improvement in pain and fatigue.	Several randomized controlled trials, meta-analysis [11, 12]
Reboxetine	Selective noradrenaline reuptake inhibitor	Improvement in pain.	Mostly case reports [13]
Esreboxetine	Selective noradrenaline reuptake inhibitor	Improvement in pain and fatigue.	Randomized controlled trial [14]
Citalopram, escitalopram, fluoxetine, paroxetine	Selective serotonin reuptake inhibitors	Improvement in pain and depression.	Randomized controlled trials, meta-analysis, guideline recommended [8–10, 12, 15, 16]
Cyclobenzaprine	5-HT2 receptor blocker	Moderately improves sleep, mild improvement in pain. Development stopped due to low efficacy.	Randomized controlled trial [17–19]
Pregabalin, gabapentin	Gabapentinoid	Improvement in pain, fatigue, and sleep abnormalities.	Randomized controlled trials, guideline recommended [8–10, 15, 20–22]
Lacosamide	Gabapentinoid	Effective in animal models. No clear evidence in FMS.	Randomized controlled trial [23]
Naltrexone	Opioid receptor antagonist, TLR-4 antagonist	Improvement in pain in depression.	Randomized controlled trial [24, 25]
Tramadol	Opioid with SNRI activity	Improvement in pain. Mostly for severe symptoms and short duration, see text.	Guideline recommended [6]
Nabilone	Cannabinoid	Improvement in pain and anxiety. Conflicting results, see text.	Randomized controlled trials, meta-analysis [26–28]
Dronabinol	Cannabinoid	Improvement in pain and depression. Conflicting results, see text.	Randomized controlled trials, meta-analysis [29]
Ketamine	NMDA antagonist	Improvement in referred pain.	Clinical trial, animal models [30]
Memantine	NMDA antagonist	Improvement in pain, conflicting evidence, see text.	Randomized controlled trials, meta-analysis [31–34]
NYX-2925	NMDA receptor modulator	Improvement in pain.	Animal models, pending clinical trials in humans [35, 36]