Pharmacological Therapy in Fibromyalgia

The management of fibromyalgia patients involves a complex interplay between pharmacological management of pain and associated symptoms and the use of non-pharmacological modalities. As the elimination of all FMS symptoms (i.e. a cure) is not currently possible; the philosophy of management is symptom palliation and functional restoration. The presentation of fibromyalgia symptomatology is highly variable and each patient must have an individualized evaluation before deciding on an initial treatment plan (10). Regular follow-up and modification of the initial management strategy is usually required, depending upon the response pattern. As in other chronic pain states there is often an existential crisis that goes through distinctive phases from denial, searching for “the cure”to eventual acceptance. The early phases of management (usually the first 2 years) require more “hand holding,”until the patient has come to terms with their new existence.