Useful treatments for fibromyalgia

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Useful treatments for fibromyalgia syndrome

Source: Journal of Family Practice > Feb, 2005

* CLINICAL QUESTION

What treatment modalities are most effective for fibromyalgia syndrome?

* BOTTOM LINE

Treatments for fibromyalgia syndrome with the strongest evidence for efficacy

include amitriptyline (Elavil), cyclobenzaprine (Flexeril), exercise, cognitive

behavioral therapy, patient education, and multidisciplinary therapy. (Level of

evidence [LOE]=1a-)

* STUDY DESIGN

Meta-analysis (other)

* SETTING

Various (meta-analysis)

* SYNOPSIS

The optimal method for treating fibromyalgia syndrome is unclear. The

investigators thoroughly searched multiple sources--including Medline,

EMBASE, Science Citation Index, and the Cochrane Collaboration--for trials

evaluating the effectiveness of treatment for fibromyalgia syndrome. A total of

505 articles were reviewed and classified according to their level of evidence.

The authors don't state whether the articles were reviewed independently and

do not discuss the potential for publication bias.

Evidence was ranked as strong (positive results from a meta-analysis or

consistent results from more than 1 randomized controlled trial [RCT]),

moderate (positive results from 1 RCT or mostly positive results from multiple

RCTs or consistently positive results from non-RCT studies), or weak (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 behavioral therapy, and patient

education. Modest evidence for efficacy was found for tramadol (Ultram),

various selective serotonin reuptake inhibitors, acupuncture, hypnotherapy,

and biofeedback. Weak evidence for efficacy was found for growth hormone

therapy, SAM (S-adenosyl-methionine), chiropractic and massage therapy,

electrotherapy, and ultrasound. No evidence of any evaluation or

effectiveness was found for steroids, nonsteroidal anti-inflammatory drugs,

melatonin, benzodiazepine hypnotics, or trigger-point injections.

Goldenberg DL, Burchhardt C, Crofford L. Management of fibromyalgia

syndrome. JAMA 2004; 292:2388-2395.