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Exercise is the only fibromyalgia treatment that has been given a strong recommendation by the European Alliance of Associations for Rheumatology . There is strong evidence indicating that exercise improves fitness, sleep and quality of life and may reduce pain and fatigue for people with fibromyalgia.
During its development for fibromyalgia, milnacipran was evaluated utilizing a composite responder approach.To be considered as a responder for the composite ‘treatment of fibromyalgia’ endpoint, each patient had to show concurrent and clinically meaningful improvements in pain, physical function, and global impression of disease status.
The drug is used to treat acute and chronic pain. It has shown effectiveness in the treatment of fibromyalgia, though it is not specifically approved for this purpose. The drug is also under investigation as an antidepressant and for the treatment of neuropathic pain. It is related in chemical structure to venlafaxine.
A review of duloxetine found that it reduced pain and fatigue, and improved physical and mental performance compared to placebo. [41] The US Food and Drug Administration (FDA) approved the drug for the treatment of fibromyalgia in June 2008. [42] [43] It may be useful for chronic pain from osteoarthritis. [44] [45]
A 2004 review found benefit for fibromyalgia symptoms, with a reported number needed to treat of 4.8 (meaning that 1 person out of every 4.8 benefits from treatment) for pain reduction, but no change in fatigue or tender points. [36] A 2009 Cochrane review found insufficient evidence to justify its use in myofascial pain syndrome. [37]
The exact medications recommended will vary by country and the individual treatment center, but the following gives an example of the WHO approach to treating chronic pain with medications. If, at any point, treatment fails to provide adequate pain relief, then the doctor and patient move onto the next step. [citation needed]