Treatment for Fibromyalgia: Nice Work When It Works

Pregabalin, known to many by its trade name, “Lyrica,” works well, when, well, it works.

A recent review of clinical studies involving Lyrica for the treatment of fibromyalgia concluded that only a minority of patients with moderate to severe fibromyalgia derive significant pain relief from pregabalin. However, the quality of that pain relief is strong.

This review is an update of one originally published in 2009, which examined the effects of pregabalin on all types of pain. In this review, the authors focused on fibromyalgia pain. The earlier review showed that pregabalin worked in a small proportion of people with fibromyalgia. This is the same as all other fibromyalgia treatments to date, and for chronic pain conditions generally.

The review included eight studies, among them three new published papers. Two of these new studies were of classic design in which patients were randomly assigned at the start of the study to pregabalin or placebo. One study used a more sensitive design called “enriched enrollment randomized withdrawal.” in which participants who had a good pain response and could tolerate the medicine were first identified and then randomly assigned to continued treatment with pregabalin or placebo.

The studies were all randomized and double-blind and included mainly women in their 50s, but they often excluded people with depression. They lasted a minimum of eight weeks; one lasted six months.

The primary outcome used was changes to the Global Impressions of Change scale. The initial average pain score of study participants was 7 of 10. Their average duration of symptoms was four years.

Substantial benefit with pregabalin at doses of 300 to 600 mg daily was experienced by about 14% of participants with placebo, but about 9% more with pregabalin 300 to 600 mg.

There was also evidence of a more moderate benefit in some patients. Pregabalin increased the number of participants experiencing at least 30% pain intensity reduction after 12 or 13 weeks of stable treatment

Pregabalin 300 to 600 mg produces a major reduction in pain intensity over 12 to 26 weeks with tolerable adverse events for a small proportion of people (about 10% more than placebo) with moderate or severe pain due to fibromyalgia. The degree of pain relief, not surprisingly, is known to be accompanied by improvements in other symptoms, quality of life, and function. These results are similar to other effective medicines in fibromyalgia (milnacipran, duloxetine).

The commercials tell us it works. The studies say it works. And now the analyzers of the studies agree.

If only it worked for everyone.