What are the best treatments for fibromyalgia?

Journal of Family Practice, July, 2008

Antidepressants, pramipexole (Mirapex and Sifrol), pregabalin (Lyrica), tramadol (Ultram), tropisetron (Navoban), and heated pool treatments provide relief for fibromyalgia pain.

Carville SF, Arendt-Nielsen S, Bliddal H, et al; for EULAR. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008;67:536-541.

Level of evidence

1a-: Systematic review of randomized trials displaying worrisome heterogeneity

These guidelines were developed by the European League Against Rheumatism (EULAR), a multidisciplinary task force of representatives from 11 European countries. To prepare this guideline, the group performed a comprehensive search and evaluation of the available medical literature, using a consensus system. Strong evidence was available only for drug therapy.

Based on a good response in several small trials, the group recommends heated pool treatments with or without exercise (strength of evidence: B). Tramadol, antidepressants, tropisetron, pramipexole, and pregabalin are effective for reducing pain, and antidepressants can improve function (strength of evidence: A).

Only weak evidence supports the use of tailored exercise programs, cognitive behavioral therapy, acetaminophen, or weak opioids. The group recommends against the use of corticosteroids or strong opioids.

No research has evaluated the relative benefits of treatment, and most of the studies have been short in duration, creating the possibility of a potent placebo effect.

STUDY DETAILS

Design Guideline

Funding Government

Setting Miscellaneous (guideline)

FAST TRACK

Heated pool treatments, with or without exercise, are effective for fibromyalgia