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] |