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Treatment of fibromyalgia in adults

Author Section Editor Deputy Editor
Don L Goldenberg, MD Peter H Schur, MD Paul L Romain, MD

Last literature review version 18.2: May 2010 | This topic last updated: June 10, 2010
INTRODUCTION — Fibromyalgia is a chronic pain disorder that is difficult to treat. It is most important
to educate the patient and family regarding the uncertainty involved in pathogenesis, diagnosis, and
treatment [1]. There is no test that confirms this diagnosis, which is currently based upon the following
clinical criterion [1]:

• Widespread musculoskeletal pain

• Excess tenderness in at least 11 of 18 predefined anatomic sites (figure 1)

The treatment of fibromyalgia will be reviewed here. Patients with fibromyalgia generally respond best to
a multidisciplinary, individualized treatment program that incorporates physician as well as non-physician
providers [2]. This includes a team of physical medicine, rehabilitation, and mental health specialists.

Other issues related to fibromyalgia, including clinical manifestations, diagnosis, the differential diagnosis
of widespread pain, pathogenesis, and fibromyalgia in children, are discussed separately. (See "Clinical
manifestations and diagnosis of fibromyalgia in adults" and "Differential diagnosis of fibromyalgia"," and
(see "Pathogenesis of fibromyalgia" and "Clinical manifestations and diagnosis of fibromyalgia in children
and adolescents").

PATIENT EDUCATION — Patients with fibromyalgia (as well as those with the myofascial pain syndrome
and the chronic fatigue syndrome) need to understand their illness before any medications are prescribed
[2,3] (see 'Information for patients' below).

• The myofascial pain syndrome may be a localized form of fibromyalgia. Patients with this disorder
complain of pain in one anatomic region, such as the right side of the neck and shoulder, and tenderness
is confined to that area [4]. (See "Overview of soft tissue rheumatic disorders", section on 'Regional
myofascial pain'.)

• There also appears to be a close relationship between the chronic fatigue syndrome and fibromyalgia.
Diagnostic criteria for the classification of chronic fatigue syndrome (CFS) are similar to those for
fibromyalgia, and the majority of patients with CFS meet tender point criteria for fibromyalgia [5];
similarly, approximately 70 percent of patients with fibromyalgia meet the criteria for CFS [6]. (See
"Clinical features and diagnosis of chronic fatigue syndrome".)

Discussing the diagnosis of fibromyalgia — Most patients have had fibromyalgia for years before the
diagnosis is finally made. They often have undergone multiple diagnostic evaluations and have consulted
with many different specialists. Some patients may feel rejected by the medical profession, while others
may fear that a life-threatening illness will eventually be found.

There is emerging evidence that a diagnosis of fibromyalgia is helpful to patients as well as society.

• One report from the United Kingdom found that there were fewer referrals and less diagnostic testing
after a fibromyalgia diagnosis was made [7].