Which medications are commonly used in the treatment of fibromyalgia and myofascial pain syndrome?
Tricyclic antidepressants are widely used drugs for these disorders. They are used because they have the potential to regularize sleep patterns, decrease pain and muscle spasm, and because of their mood-enhancing properties. However, many tricyclic antidepressants are on the Beers List of drugs that are potentially inappropriate for the elderly and not allowed by Medicare. Selective serotonin-reuptake inhibitors (SSRIs) are used to elevate mood, but have little analgesic effect. Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine and milnacipran, have recently been shown to have pain-reducing properties in patients with fibromyalgia and can also improve mood. Pregabalin, milnacipran, and duloxetine have received an indication for the treatment of fibromyalgia in the United States. Nonsteroidal antiinflammatory drugs (NSAIDs), opioids, and nonnarcotic analgesics are also frequently used, but their role is also unclear and not evidence based. Many medications, such as cyclobenzaprine, baclofen, tizanidine, and chlorzoxazone, have been used to achieve symptom relief. However, a treatment effect has not been consistently supported. Medications that target associated symptoms are often employed. Among the most common of these are sleep medications such as zolpidem and fludrocortisone to treat postural hypotension and adynamia.