Clinical Question: What treatment modalities are most effective for fibromyalgia syndrome?

Setting: Various (meta-analysis)

Study Design: Meta-analysis (other)

Synopsis: The authors searched multiple sources, including MEDLINE, EMBASE, Science Citation Index, and the Cochrane Collaboration, for trials on the efficacy of fibromyalgia syndrome therapy. A total of 505 articles were reviewed and classified according to their level of evidence. It was unclear whether the articles were reviewed independently and the potential for publication bias. was not discussed. Evidence was ranked as strong (i.e., positive results from a meta-analysis or consistent results from more than one randomized controlled trial [RCT]), moderate (i.e., positive results from one RCT or mostly positive results from multiple RCTs or consistently positive results from non-RCT studies), or weak (i.e., positive results from descriptive and case studies, inconsistent results from RCTs, or both).

Strong evidence for efficacy was found for treatment with amitriptyline, cyclobenzaprine, exercise, cognitive behavior therapy, and patient education. Moderate evidence for efficacy was found for tramadol, various selective serotonin reuptake inhibitors, acupuncture, hypnotherapy, and biofeedback. Weak evidence for efficacy was found for growth hormone therapy, S-adenosyl-methionine, chiropractic and massage therapy, electrotherapy, and ultrasonography. No evidence of any evaluation or effectiveness was found for steroids, nonsteroidal anti-inflammatory drugs, melatonin, benzodiazepine hypnotics, or trigger point injections.

Bottom Line: Treatments for fibromyalgia syndrome with the strongest evidence for efficacy include amitriptyline, cyclobenzaprine, exercise, cognitive behavior therapy, patient education, and multidisciplinary therapy. (Level of Evidence: 1a–)