Treatment Selection in Fibromyalgia


Philip J. Mease, MD, discusses treatment selection in fibromyalgia, highlighting combination therapy as well as the importance of a holistic approach to care.

This is a video synopsis/summary of a panel discussion involving Philip J. Mease, MD.

When introducing medications for fibromyalgia, choosing the appropriate one involves considering patient experiences and individual symptoms. For instance, if a patient emphasizes debilitating fatigue alongside pain, Milnacipran might be a preferred option due to its efficacy in addressing fatigue. However, patient-specific factors, such as high blood pressure concerns, may guide the selection of alternative medications like duloxetine or pregabalin.

Trial and error play a significant role in finding the most effective treatment, with adjustments based on symptom relief and tolerance of potential side effects. Combining medications, such as a small dose of pregabalin with an SNRI (serotonin and norepinephrine reuptake inhibitors) like duloxetine or milnacipran, is a strategy to simultaneously inhibit neuropeptides in the ascending pain pathway and boost the inhibitory side of pain signaling, potentially reducing side effects.

Beyond pharmacological interventions, a holistic approach to fibromyalgia care is crucial. This encompasses psychological counseling, regular conditioning exercises (such as swimming, which has shown benefits for musculoskeletal symptoms and fatigue), and improved sleep hygiene. Encouraging patients to explore alternative paths to physical activity, like swimming, emphasizes the importance of tailoring treatments to individual preferences and circumstances. In summary, comprehensive fibromyalgia care involves a thoughtful combination of medication management and multidisciplinary strategies to address the diverse aspects of this complex condition.

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

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