Treatment

Clinical practice guidelines by the European League Against Rheumatism (EULAR ) recommendations (parentheses contain levels of evidence and strength of recommendation) are included below. [15]

General

"Full understanding of fibromyalgia requires comprehensive assessment of pain. function and psychosocial context. Fibromyalgia should be recognised as a complex and heterogeneous condition where there is abnormal pain processing and other secondary features" (IV D) "Optimal treatment requires a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities tailored according to pain intensity, function, associated features such as depression, fatigue and sleep disturbance in discussion with the patient" (IV D)

Despite different modes of action, a variety of neuromodulatory agents may improve the symptoms of fibromyalgia patients. These include antidepressants. analgesics. anticonvulsants. muscle relaxants. and sedative hypnotic drugs. Only 2 drugs are FDA-approved for the specific treatment of fibromyalgia: pregabalin (Lyrica®) and duloxetine hydrochloride (Cymbalta®). [13]

Non-pharmacological management

"Heated pool treatment with or without exercise is effective in fibromyalgia" (IIa B) "Individually tailored exercise programmes, including aerobic exercise and strength training can be beneficial to some patients" with fibromyalgia" (IIb C). Subsequent to the 2008 EULAR clinical practice guidelines. a meta-analysis of randomized controlled trials found "aerobic-only training has beneficial effects on physical function and some FM symptoms. Strength-only training may improve FM symptoms, but requires further study." [16] "Cognitive behavioural therapy may be of benefit to some patients with fibromyalgia" IV D) "Other therapies such as relaxation, rehabilitation, physiotherapy and psychological support may be used depending on the needs of the individual patient (IIb C)

In addition:

Tai Chi was helpful in an unblinded study. [17] Cognitive behavioral therapy " provided a small incremental benefit over control interventions in reducing pain, negative mood and disability at the end of treatment and at long-term follow-up" according to the Cochrane Collaboration. [18] Musculoskeletal manipulation may help. [19]

Pharmacological management