What 151 trials say fibromyalgia medicines can change, with sleep moving more than pain

151 trials. 32,592 people with fibromyalgia. Four decades of drug research, from studies published in the late 1980s to compounds that are still investigational.

A team at McMaster University in Canada pooled all of it in a review published on 5 October in BMJ Medicine (Zeraatkar and colleagues, 2026). They used a network analysis, a method that lets researchers compare medicines that were never tested against each other directly, which matters here because almost no fibromyalgia trial puts two drugs side by side. The full paper is free to read (PubMed Central, 2026).

Their conclusion is careful, and it's worth reading slowly: several drug classes "may provide typically small benefits in select outcomes." Here is what sits behind that sentence.

1. Small gains, in specific places

Four classes may raise the chance that a person reports feeling meaningfully better: sodium oxybate, selective noradrenaline reuptake inhibitors (a newer group, still investigational), SNRIs (such as duloxetine and milnacipran) and gabapentinoids (such as pregabalin). Out of every thousand people, that came to somewhere between about 105 and 283 more saying they felt better than with placebo or usual care. Sodium oxybate and SSRIs may ease the total symptom score. Tricyclic antidepressants, gabapentinoids and sodium oxybate may improve sleep quality.

All of this sits at low certainty, the authors' own grading. In their words, low certainty evidence may be substantially different from the true effect, and it can shift as new trials come in.

2. Average pain barely moved

No drug's pooled effect on pain intensity, physical health or mental health reached the size the team had set as clinically important.

That does not mean nobody's pain changed. For sodium oxybate, the selective noradrenaline reuptake inhibitors, SNRIs and cyclobenzaprine, one or two more people in every ten saw their pain fall by at least 30% compared with placebo or usual care. An average describes a group, not the person in it. It can hide a smaller group who improve a lot sitting next to many who barely change, and the authors read their own numbers that way too.

3. Feeling better is not the same as hurting less

Most of the benefit showed up on one measure, a scale that asks people to compare how they feel now with how they felt before treatment. The paper spends real time on this. Such a scale folds pain, mood, sleep, coping and daily function into a single judgement, so a person can feel better in general while the pain score stays where it was. It is also, the authors note, more open to memory and expectation, especially when side effects let people guess which pill they were given.

Both readings can be true at once.

4. Short trials, a narrow slice of people

The median trial followed people for 12 weeks, and only nine of the 151 reported anything past six months, which matters for a condition people live with for years. Around 60% of the trials were industry funded, and the team flagged 15 with concerns about trustworthiness. Nearly all enrolled people under the 1990 tender point criteria, a narrower definition than the one doctors use today; the average participant was about 47, and only four trials included more than 30% men. Two options people often ask about, medical cannabis and low dose naltrexone, lacked evidence of benefit, which is not the same as proof that nobody responds. Sodium oxybate, among the stronger performers, carries serious safety warnings that restrict its use, and the trials were too brief to see rare or long term harms for any drug. None of this says medicines have nothing to offer. It says the picture is smaller, and less certain, than a list of effective drugs would suggest.

From the inside

For a practitioner, the gap in point 3 is the most interesting line in the paper: people saying they feel better while the pain number holds. Again and again in my classes, someone will tell me the pain is about the same, and in the same breath that getting out of bed is less of an event, or that the afternoon no longer collapses. From the inside, change often shows up first as more room around the pain, and only later, if at all, as less pain.

A Feldenkrais® lesson works in that room. Small movements, done slowly, where you only go where it feels easy, pleasant, and comfortable, so a sensitized nervous system gets a chance to notice options it stopped using.

Where this leaves you

Whether to start, keep or change a medicine is a decision for you and your doctor, and this review doesn't make it for anyone. What it offers is a more realistic picture to bring into that conversation, including a useful question: which outcome matters most to you right now? If it's sleep, several classes showed a signal there, and sleep and physical tension tend to feed each other in ways movement can touch. If it's pain intensity, the averages are modest, and it's fair to ask what a meaningful change would look like for you, how long a trial of a medicine should run, and how you'd both decide whether any benefit is worth the side effects.

The authors end by asking for trials that compare drugs with care that doesn't involve drugs, and for follow up past a year. Gentle movement practice, like the Feldy online movement program, is one kind of care without drugs; it doesn't replace clinical care, and it can run alongside whatever you and your doctor decide.

If the pain score stayed exactly where it is this winter, what is the one thing in your day you'd most want to feel different?