How effective are NSAIDs in the treatment of fibromyalgia?
— Warner W. Carr, MD
El Paso, Tex
As monotherapy, NSAIDs are no different from placebo in the treatment of fibromyalgia.1 The only documented successful use of NSAIDs in this setting has been as combination therapy— an NSAID with either a muscle relaxant (naproxen and cyclobenzaprine2) or an anxiolytic agent (ibuprofen and alprazolam3). However, NSAIDs have consistently produced pain relief comparable to that of narcotic analgesics in studies of patients with other chronic rheumatic conditions, such as rheumatoid arthritis and osteoarthritis; soft tissue complaints, such as bursitis and tendinitis; and pain such as that produced by dental surgery.4 Since there is no effective treatment of fibromyalgia, we typically prescribe NSAIDs in the hope that they will provide some pain relief—and to avoid the habituation seen with narcotic analgesics. Tramadol, an analgesic with minimal narcotic properties, is somewhat effective in patients with fibromyalgia.5 However, its benefits are not dramatic.
—— Peng Thim Fan, MD
Clinical Professor of Medicine
Division of Rheumatology
University of California, Los Angeles,
School of Medicine
1. Goldenberg DL, Felson DT, Dinerman H. A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum. 1986;29:1371-1377.
2. Simms RW, Relson DT, Goldenberg DL. Development of preliminary criteria
for response to treatment in fibromyalgia syndrome. J Rheumatol. 1991;18:
3. Russell IJ, Fletcher EM, Michalek JE, et al. Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam. A double-blind, placebocontrolled study. Arthritis Rheum. 1991;34:552-560.
4. Katz N. The impact of pain management on quality of life. J Pain Symptom Manage. 2002;24:938-947.
5. Biasi G, Manca S, Manganelli S, Marcolongo R. Tramadol in the fibromyalgia syndrome: a controlled clinical trial versus placebo. Int J Clin Pharmacol Res. 1998;18:13-19.