Relieving the pain of fibromyalgia

In some people, a combination of medicines, such as amitriptyline and fluoxetine, may be more effective than either alone. Most of these medications have not been compared directly with each other in studies of fibromyalgia. So, it's impossible to know if one is truly better than another. In addition, the overall success rate for medication treatment of fibromyalgia is modest at best.

With regard to safety, none of these medications is clearly safer than the others. Each may cause side effects. Some of the side effects can be minimized by starting at low doses and increasing doses gradually. Start with a low dose before bed and increase the night-time dose if no side effects occur. Then add a low dose during the day. Again increase the dose as tolerated.

Keep in mind that medication is just one of options to treat fibromyalgia. Because medications may cause side effects and may not work in this disorder, it's important to explore other options.

For example, exercise and physical therapy may be more effective than medication treatment. While people with this condition usually feel unable to exercise, most can do so as long as they start slowly and increase exercise duration and intensity slowly.

Today's column was written by Robert H. Shmerling, M.D., an associate physician at Beth Israel Deaconess Medical Center, Boston, Mass., and associate professor at Harvard Medical School. For additional health information, visit health.harvard.edu.