What are the most effective treatment modalities available for fibromyalgia or other myofascial pain syndromes when tricyclic antidepressants are not well tolerated?
—Mary Anderson, FNP, Visalia, Calif.

Fibromyalgia affects an estimated 4.2% of people in the United States (predominantly women). Largely because researchers still cannot pinpoint the exact cause of fibromyalgia, there is no specific treatment.

Tricyclic antidepressants have long been the mainstay. The goal is to regulate and restore a more normal sleep cycle. When tricyclics are not tolerated, other medications that are sometimes effective include duloxetine (Cymbalta), venlafaxine (Effexor), gabapentin (Neurontin), and most recently, pregabalin (Lyrica).

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All these medications have the same basic goal—restoration of a normal sleep cycle and pain relief. Traditional therapies of low-impact exercise, massage, and proper diet are still essential for best outcomes.
—Sherril Sego, MSN, FNP (121-14)