Pregabalin in Fibromyalgia — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyPregabalin in FibromyalgiaSCE Rheumatology

A 50-year-old woman with fibromyalgia has persistent widespread pain despite an individualised exercise programme, cognitive behavioural therapy, amitriptyline and duloxetine. She is not currently taking a gabapentinoid. Which is the most appropriate next step regarding drug treatment according to current UK guidance?

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Correct answer: C — Do not initiate pregabalin for fibromyalgia

The correct answer is C. NICE classifies fibromyalgia as chronic primary pain and advises against initiating antiepileptic drugs, including pregabalin and gabapentin, because evidence does not show clinically important overall benefit and these medicines carry risks of adverse effects, dependence and misuse. Pregabalin is also not licensed for fibromyalgia in the UK. Management should remain person-centred, with reassessment and optimisation of supported non-pharmacological strategies rather than serial analgesic escalation. Naproxen, corticosteroids and opioids, including tramadol, should likewise not be initiated solely for chronic primary pain. The older EULAR recommendations gave pregabalin a weak-for role in severe pain or sleep disturbance, but that historical European position is not the appropriate prescribing answer under current UK NICE guidance.

Reference: National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, NG193, recommendations 1.2.10 and Terms used, 2021. https://www.nice.org.uk/guidance/ng193/chapter/recommendations