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 .
A European Multicenter Randomized Double-blind Placebo-controlled Monotherapy Clinical Trial of Milnacipran in Treatment of Fibromyalgia
Objective . This r and omized , double-blind , placebo-controlled , multicenter study investigated the efficacy and safety of milnacipran in the treatment of fibromyalgia ( FM ) in a European population . Methods . Out patients diagnosed with FM according to 1990 American College of Rheumatology criteria ( N = 884 ) were r and omized to placebo ( n = 449 ) or milnacipran 200 mg/day ( n = 435 ) for 17 weeks ( 4-week dose escalation , 12-week stable dose , 9-day down-titration ) , followed by a 2-week posttreatment period . The primary efficacy criterion was a 2-measure composite responder analysis requiring patients to achieve simultaneous improvements in pain ( ≥ 30 % improvement from baseline in visual analog scale , 24-hour morning recall ) and a rating of “ very much ” or “ much ” improved on the Patient Global Impression of Change scale . If responder analysis was positive , Fibromyalgia Impact Question naire ( FIQ ) was included as an additional key primary efficacy measure . Results . At the end of the stable dose period ( Week 16 ) , milnacipran 200 mg/day showed significant improvements from baseline relative to placebo in the 2-measure composite responder criteria ( p = 0.0003 ) and FIQ total score ( p = 0.015 ) . Significant improvements were also observed in multiple secondary efficacy endpoints , including Short-Form 36 Health Survey ( SF-36 ) Physical Component Summary ( p = 0.025 ) , SF-36 Mental Component Summary ( p = 0.007 ) , Multidimensional Fatigue Inventory ( p = 0.006 ) , and Multiple Ability Self-Report Question naire  ( p = 0.041 ) . Milnacipran was safe and well tolerated ; nausea , hyperhidrosis , and headache were the most common adverse events . Conclusion . Milnacipran is an effective and safe treatment for pain and other predominant symptoms of FM . Registered as trial no. NCT00436033
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 .