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Clinical inquiries. For fibromyalgia, which treatments are the most effective?

Reassure patients that their condition is real and treatable The care of patients with fibromyalgia can be very challenging. An important component of successful management of these patients’ condition is helping them realize that we, as physicians, believe that their pain is real. It is important to reassure them that even though fibromyalgia is not curable, it is treatable and is not a life-threatening condition. Based on expert opinion, combining 2 or more of treatments with the best supporting evidence for effectiveness seems to be the most successful approach to the management of fibromyalgia syndrome. There is no single most effective modality for the treatment of fibromyalgia syndrome, and no objective comparison of the results from the different studies is available. Low-dose tricyclic antidepressants (TCAs) improve sleep quality and global well-being and have a moderate beneficial effect on tenderness and stiffness (strength of recommendation [SOR]: A, based on a systematic review of randomized controlled trials [RCTs]). Selective serotonin reuptake inhibitors (SSRIs) may moderately improve fibromyalgia-related symptoms (SOR: B, based on a few RCTs). The serotonin and norepinephrine reuptake inhibitors (SNRIs) duloxetine (Cymbalta) and milnacipran (Ixel, not currently available in the US) improve pain and other symptoms (SOR: B, based on single RCTs). Tramadol (Ultram) improves pain and other outcomes (SOR: A, based on a few RCTs). Cyclobenzaprine (Flexeril) improves both pain and sleep quality (SOR: A, based on a systematic review of RCTs). Aerobic exercise improves overall functional capacity and sense of well-being for patients with fibromyalgia (SOR: A, based on a systematic review of RCT). Cognitive behavioral therapy improves patients’ self-reported symptoms (SOR: A, based on RCTs).