While no clinical trial to date has specifically targeted fatigue , r and omized controlled trials , systematic review s , and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue .
Fatigue is a disabling , multifaceted symptom that is highly prevalent and stubbornly persistent .
Although fatigue is a frequent complaint among patients with fibromyalgia , it has not received the same attention as pain .
Reasons for this include lack of st and ardized nomenclature to communicate about fatigue , lack of evidence -based guidelines for fatigue assessment , and a deficiency in effective treatment strategies .
Fatigue does not occur in isolation ; rather , it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain , unrefreshing sleep , anxiety , depression , cognitive difficulties , and so on .
Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms .
The Efficacy and Safety of Milnacipran for Treatment of Fibromyalgia. A Randomized, Double-blind, Placebo-controlled Trial
Objective . To evaluate the safety and efficacy of milnacipran , a dual norepinephrine and serotonin reuptake inhibitor , in the treatment of fibromyalgia ( FM ) . Methods . A 27-week , r and omized , double-blind , multicenter study compared milnacipran 100 and 200 mg/day with placebo in the treatment of 888 patients with FM . Two composite responder definitions were used to classify each patient ’s individual response to therapy . “ FM responders ” concurrently satisfied response criteria for improvements in pain ( visual analog scale 24-h morning recall ) , patient global impression of change ( PGIC ) , and physical functioning ( SF-36 Physical Component Summary ) ; while “ FM pain responders ” concurrently satisfied response criteria for improvements in pain and PGIC . Results . At the primary endpoint , after 3-month stable dose treatment , a significantly higher percentage of milnacipran-treated patients met criteria as FM responders versus placebo ( milnacipran 200 mg/day , p = 0.017 ; milnacipran 100 mg/day , p = 0.028 ) . A significantly higher percentage of patients treated with milnacipran 200 mg/day also met criteria as FM pain responders versus placebo ( p = 0.032 ) . Significant pain reductions were observed after Week 1 with both milnacipran doses . At 15 weeks , milnacipran 200 mg/day led to significant improvements over placebo in pain ( realtime , daily and weekly recall ; all measures , p < 0.05 ) , PGIC ( p < 0.001 ) , fatigue ( p = 0.016 ) , cognition ( p = 0.025 ) , and multiple SF-36 domains .  Milnacipran was safe and well tolerated by the majority of patients during 27 weeks of treatment ; nausea and headache were the most common adverse events . Conclusion . Milnacipran is safe and effective for the treatment of multiple symptoms of FM
While no clinical trial to date has specifically targeted fatigue , r and omized controlled trials , systematic review s , and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue .
Fatigue is a disabling , multifaceted symptom that is highly prevalent and stubbornly persistent .
Although fatigue is a frequent complaint among patients with fibromyalgia , it has not received the same attention as pain .
Reasons for this include lack of st and ardized nomenclature to communicate about fatigue , lack of evidence -based guidelines for fatigue assessment , and a deficiency in effective treatment strategies .
Fatigue does not occur in isolation ; rather , it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain , unrefreshing sleep , anxiety , depression , cognitive difficulties , and so on .
Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms .