Table 4 EULAR recommendations for the management of fibromyalgia
RecommendationLevel of evidenceStrength
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 featuresIVD
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 patientIVD
Non-pharmacological management
Heated pool treatment with or without exercise is effective in fibromyalgiaIIaB
Individually tailored exercise programmes, including aerobic exercise and strength training can be beneficial to some patients with fibromyalgiaIIbC
Cognitive behavioural therapy may be of benefit to some patients with fibromyalgiaIVD
Other therapies such as relaxation, rehabilitation, physiotherapy and psychological support may be used depending on the needs of the individual patientIIbC
Pharmacological management
Tramadol is recommended for the management of pain in fibromyalgiaIbA
Simple analgesics such as paracetamol and other weak opioids can also be considered in the treatment of fibromyalgia. Corticosteroids and strong opioids are not recommendedIVD
Antidepressants: amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide and pirlindole, reduce pain and often improve function, therefore they are recommended for the treatment of fibromyalgiaIbA
Tropisetron, pramipexole and pregabalin reduce pain and are recommended for the treatment of fibromyalgiaIbA