Management of psychiatric comorbidities in fibromyalgia patients treated with pregabalin versus milnacipran

Document Type

Abstract

Publication Date

6-1-2025

Abstract

Fibromyalgia is a debilitating chronic disease with symptoms of pain and fatigue that profoundly impact a patient's quality of life. This can lead to the development of psychiatric comorbidities causing compounding decline in overall well-being. While the treatment options available for fibromyalgia are limited, pregabalin (a y-aminobutyric acid analog) and milnacipran (a serotonin-norepinephrine reuptake inhibitor) are options for patients seeking relief. Based on these mechanisms of action, it is likely that milnacipran might be more effective at treating and preventing comorbid psychiatric conditions than pregabalin. We used TrinetX, deidentified health care organization (HCO) network, to collect and analyze our data. Patients with fibromyalgia who were not receiving opioid analgesics were included in the study, and separated into treatment groups if they were prescribed pregabalin or milnacipran. Risk ratios, hazard ratios, Kaplan Meier analysis, and log rank test were performed to analyze the differences in psychiatric comorbidities, somnolence, opioid use disorder, depressive episodes, and anxiety disorder. Our results suggest that milnacipran has a statistically significant decreased in risk of somnolence (1.3%, CI 95%= 0.9-1.8%, p=0.00010. opioid use disorder (0.9%, CI 95%=0.6-1.2%, p0.0001) and depressive episodes (2.7%, CI 95% = 1.5-4.0%, p=0.0001) compared to the pregabalin group, but no significant difference when comparing anxiety disorder (1%, CI 95%=-0.3-2.3% p+0.119). log rank tests also show that all patients treated with milnacipran had a statistically significant increase in time to diagnosis for all psychiatric conditions assessed compared to pregabalin (somnolence 10.12%, p0.001; opioid use disorder 1.6%, p0.001; depressive episode 7.77%, p=0.001; anxiety disorder 4.48%, p=0,008). Overall, the data suggest that milnacipran might be more effective at reducing psychiatric comorbidities and overall increase the time to psychiatric diagnoses of these patients. However, further research is needed to determine the clinical significance of these findings.

Publication Title

Clinical and Experimental Rheumatology

Volume

43

Issue

6

First Page

1184

Last Page

1184

Comments

7th International Congress on Controversies in Fibromyalgia held 2025-03-03 to 2025-03-04 in Vienna, Austria.

Link to Full Text

Open Access

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