Clinical characteristics and medication uses among fibromyalgia patients newly prescribed amitriptyline, duloxetine, gabapentin, or pregabalin

Arthritis Care Res (Hoboken). 2013 Nov;65(11):1813-9. doi: 10.1002/acr.22071.


Objective: Fibromyalgia is a common chronic pain disorder with unclear etiology. No definitive treatment is available for fibromyalgia, and treatment with antidepressants or antiepileptics is often used for symptom management.

Methods: Using US health care utilization data, a large population-based cohort study was conducted to describe clinical characteristics and medication use patterns in patients diagnosed with fibromyalgia who newly started amitriptyline, duloxetine, gabapentin, or pregabalin.

Results: There were 13,404 amitriptyline starters, 18,420 duloxetine starters, 23,268 gabapentin starters, and 19,286 pregabalin starters. The mean age ranged from 48–51 years and 72–84% in each group were women. Back pain was the most frequent comorbidity in all 4 groups (range 48–64%) and hypertension, headache, depression, and sleep disorder were also common. The median daily dose at the start of followup was 25 mg for amitriptyline, 60 mg for duloxetine, 300 mg for gabapentin, and 75 mg for pregabalin, and >60% of patients remained on the same dose throughout the follow up period. Only one-fifth of patients continued the treatment started for ≥1 year. The mean number of different prescription drugs at baseline ranged from 8–10 across the groups. More than one-half of patients took opioids and one-third took benzodiazepines, sleep disorder drugs, and muscle relaxants.

Conclusion: Patients who started 1 of the 4 common drugs for fibromyalgia similarly had multiple comorbidities and other fibromyalgia-related medication use, but continued the treatment only for a short time. The dose of the 4 drugs was not increased in most patients during the followup period.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amines / administration & dosage*
  • Amitriptyline / administration & dosage*
  • Analgesics / administration & dosage
  • Anti-Anxiety Agents / therapeutic use
  • Antidepressive Agents / administration & dosage
  • Cyclohexanecarboxylic Acids / administration & dosage*
  • Disease Progression
  • Duloxetine Hydrochloride
  • Female
  • Fibromyalgia / diagnosis
  • Fibromyalgia / drug therapy
  • Fibromyalgia / physiopathology
  • Follow-Up Studies
  • Gabapentin
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement / methods*
  • Pregabalin
  • Prescription Drugs / administration & dosage*
  • Retrospective Studies
  • Thiophenes / administration & dosage*
  • Treatment Outcome
  • gamma-Aminobutyric Acid / administration & dosage
  • gamma-Aminobutyric Acid / analogs & derivatives*


  • Amines
  • Analgesics
  • Anti-Anxiety Agents
  • Antidepressive Agents
  • Cyclohexanecarboxylic Acids
  • Prescription Drugs
  • Thiophenes
  • Amitriptyline
  • Pregabalin
  • gamma-Aminobutyric Acid
  • Gabapentin
  • Duloxetine Hydrochloride