This is a video synopsis of a discussion involving Daniel J. Clauw, MD, a professor of anesthesiology, medicine/rheumatology, and psychiatry at the University of Michigan. Dr. Clauw outlines the pharmacologic options for fibromyalgia, highlighting the three drugs approved by the Food and Drug Administration (FDA) in the United States: duloxetine, pregabalin (gabapentinoid), and milnacipran (norepinephrine, serotonin reuptake inhibitor).

Pregabalin, a gabapentinoid, likely works by reducing the release of excitatory neurotransmitters in the brain, thereby dampening the volume control on pain. Dr. Clauw emphasizes the importance of using gabapentinoids at bedtime to improve sleep depth, crucial for individuals with fibromyalgia. Duloxetine and milnacipran, both serotonin-norepinephrine reuptake inhibitors, differ in their noradrenergic effects, with milnacipran being more noradrenergic. Norepinephrine is deemed crucial for pain reduction and fatigue improvement.

While all three drugs demonstrate efficacy in approximately one out of three to four individuals, their overall effectiveness is as good as it gets in the pain management field. Dr. Clauw acknowledges that real-life experience over the past decade aligns with the data from original trials, indicating that only a subset of individuals continues on these therapies for the long term. The discussion underscores the current state of fibromyalgia pharmacotherapy and the ongoing challenges in achieving optimal outcomes for individuals with fibromyalgia.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.