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Abstract

The medication guidelines for fibromyalgia (FM) and neuropathic pain (NP) were mainly based on scientific evidence of analgesic efficacy in the literature. From a scientific viewpoint, it is justified, however, it does not necessarily agree with clinical priority. Adverse effects slightly affect these guidelines. Most adverse effects that were considered in the development of guidelines for NP including FM were short-term adverse effects such as drowsiness, nausea, vomiting, diarrhea, constipation, dysuria, and dry mouth. However, the long-term adverse effects such as cognitive dysfunction, dependence or abuse, sexual dysfunction, fracture, and osteoporosis also should be considered in medication. The adverse effects of pregabalin are cognitive dysfunction, dependence or abuse, obesity, marked drowsiness (sometimes loss of consciousness), and an expensive price. The adverse effects of duloxetine are cognitive dysfunction, dementia, sexual dysfunction, and bleeding and the drug price is expensive. Tricyclic antidepressants are safer than serotonin noradrenaline reuptake inhibitors in terms of dementia or cognitive dysfunction. The price of amitriptyline is inexpensive and most adverse effects except obesity disappear as soon as it is discontinued. Many studies have shown the analgesic effect of amitriptyline in FM and NP. However, scientific evidence of efficacy is low, because they are old studies. In clinical practice, efficacy based on personal experience, adverse effects based on personal experience and scientific evidence, drug price, and degree of offlabel use in addition to scientific evidence of efficacy should be reflected in the order of priority. Pregabalin and duloxetine should be administered after amitriptyline in medication treatment for NP including FM.

Keywords: Fibromyalgia; Neuropathic pain; Medication guideline