Fibromyalgia is a chronic pain disorder associated with multiple debilitating symptoms and high disease-related costs. This analysis reviewed randomised controlled trials of tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs) and monoamine oxidase inhibitors (MAOIs).
Overall, treatment was associated with a statistically significant reduction in pain, fatigue, depressed mood and sleep disturbance. There was also an improvement in health-related quality of life.
When analysed separately, the pain benefit effect size was largest for TCAs (Standardised Mean Difference -1.64, 95% CI –2.57 to –0.71). The effect was moderate with MAOIs (SMD, –0.54; 95% CI, –1.02 to –0.07) and smallest with SSRIs (SMD, –0.39; 95% CI, –0.77 to –0.01) and SNRIs (SMD, –0.36; 95% CI, –0.46 to –0.25). SSRIs were better for depressed mood and SNRIs were better for sleep disturbances.
The authors conclude that antidepressant medication is associated with improvements in outcomes. They also note that all of the studies were relatively short in duration and therefore further work is recommended to examine long term benefits.
Action: Clinicians may find this review useful in aiding treatment choice depending upon symptom presentation. TCAs would appear to be a good first line choice for pain reduction and may have been ranked less effective in depression as a consequence of the low doses used to treat pain symptoms.
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