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Fibromyalgia Basics

Fibromyalgia Medications
– for Pain, Fatigue, Brain Fog & Sleep 

Photo of fibromyalgia medications for treating pain, fatigue, brain fog, and sleep.

A combination approach using medications, nondrug therapies, and self-help strategies is the best way to tame the symptoms of fibromyalgia. However, the advantage of medications is that they don’t consume precious time and many are covered by insurance.

Most medications work in the central nervous system (CNS) reduce pain, boost alertness, or help with sleep. Although you may be eager for symptom relief, try only one new medication at a time. Otherwise, you will not know which drug is helping and which one is causing side effects. Also don’t expect one drug to do it all. Most fibromyalgia patients require two to four different medications.

Many of the CNS-acting fibromyalgia medications also help reduce the pain of irritable bowel, bladder discomfort, jaw pain, and migraine headaches. However, doctors often prescribe additional therapies to get these conditions under so they don’t exacerbate your fibromyalgia. When trying a new drug, chart your progress and move on if it doesn’t work within a month. See our article: Considering a New Med?

Below is an overview of your medication options, including links to articles on how best to use each drug.

Pain-Relievers

  • Boosting Your Brain Chemicals: Serotonin and norepinephrine work together in the brain and spinal cord to tone down pain-related messages. Ideally you want to boost these two substances to improve your body’s pain-fighting ability. Two fibromyalgia medications that increase both transmitters are: duloxetine and milnacipran (Savella, no generic available).1,2 Another option is the new drug, Tonmya, but it is pricy. All three are FDA-approved for fibromyalgia. Other medications that are more sedating (so taken at bedtime) include amitriptyline and cyclobenzaprine. While all these agents are antidepressants, they are prescribed for their ability to relieve fibromyalgia pain.
  • Slowing Down the Signals: Your muscles and other tissues that hurt send signals to your spinal cord that are interpreted as pain. Certain anticonvulsant drugs, such as pregabalin (Lyrica) and gabapentin (Neurontin), minimize the impact of these signals by increasing the pain-fighter, GABA. Pregabalin is an FDA-approved fibromyalgia medication, and it may also aid sleep.3
  • Relaxing the Muscles: People with fibromyalgia have tight, knotted muscles that refuse to relax. Treatment for this muscle tension may include a prescription for a muscle relaxant, such as tizanidine or cyclobenzaprine (beware that both are sedating).
  • Low-Dose Naltrexone (LDN): Instead of targeting the neurons, LDN works to quiet down the immune cells in the CNS.4 These cells are activated in fibromyalgia patients, causing your neurons to malfunction and ramp up your pain. An AFSA-funded trial shows LDN benefits one-third of patients, and the side effects are mild. Read more about how low-dose naltrexone works, advice on giving LDN your best shot, and how to get it from a compounding pharmacy.

Fibromyalgia Medications for Sleep

Most fibromyalgia patients wake up in the morning feeling stiff and achy (e.g., like roadkill). This is due to disrupted sleep that fails to rejuvenate you. Patients often benefit from medications targeting insomnia and limb movements.

  • Insomnia Meds: Treatment for non-restorative sleep often involves medications used for people with insomnia as well as sedating drugs. There are multiple classes of meds that may help. Examples include doxepin, pregabalin, Dayvigo, Quviviq, ramelteon, and eszopiclone. See our article Sleep Treatments for Fibromyalgia.
  • Restless Legs Syndrome Drugs: Restless legs syndrome (RLS) and associated limb movements during sleep occurs in one-third of fibromyalgia patients. See our article on the diagnosis and treatment of RLS.

Fatigue & Brain Fog Busters

After pain, fibromyalgia patients rate fatigue as their second worst symptom. It is much more severe than “ordinary tiredness” and significantly impacts daily function. If your thyroid function is normal and you are are too tired to get through the day, one of the medications below can help.

  • Serotonin Boosters: Certain medications that raise serotonin are highly alerting and can reduce fatigue. Examples include fluoxetine, escitalopram, and sertraline.
  • Alerting Agents: Modafinil and armodafinil both raise dopamine and other neurotransmitters to improve alertness and cognitive functions but are regulated drugs. Buproprion is another medication that increases brain dopamine and is not regulated. It improves mood and mildly relieves fatigue.

  • Learn More: See our articles on Fatigue Treatments and Reducing Brain Fog.

Alternatives

  • Memantine: The NMDA receptors are magnifying the incoming signals to the spinal cord, making the pain worse. Memantine works to counter the pain-enhancing impact of the NMDAs and increases dopamine to improve cognition. However, high doses of this medication interfere with cognitive functions.
  • Lidocaine: Giving this medication intravenously (IV) shows promise but it’s costly and more research is needed. Alternatively, lidocaine patches and gels applied topically to the skin reduce muscle pain in the area beneath the skin.5 It is the more affordable option, but the patches/gels are not practical for relieving the body-wide pain of fibromyalgia. On the plus side, patches and gels are available over the counter, so you can easily test them out.
  • Cannabis/Cannabinoids: Although controversial, medical cannabis might help with pain and sleep in fibromyalgia patients. It’s used to treat fibromyalgia in Canada. The drug is also legal in more than half of the states in the U.S. and an estimated 25 percent of patients reap significant benefits from cannabis.6 More research is needed but one large AFSA-funded cannabis trial is already underway.

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Learn why a variety of treatment approaches are required. See What is Fibromyalgia?, Managing Fibro Pain, and What Causes Fibromyalgia?

References for Fibromyalgia Medications

  1. Migliorini F, at al. J Orthopaed Surg Res 18:504, 2023. Free Report
  2. Pickering G, et al. Drug Des Dev Ther 12:2485-2496, 2018. Free Report
  3. Harris RE, et al. Anesthesiology 119(6):1453-64, 2013.
  4. Aitcheson N, et al. Aust J Gen Pract 52(4):189-195, 2023. Free Report
  5. Affaitati G, et al. Clin Therapeutics 31:705-720, 2009.
  6. Giorgi V, et al. Clin Exp Rheum 38(Suppl 123):53-59, 2020. Free Report