BMJ  2005;330 (29 January), doi:10.1136/bmj.330.7485.0-g

Filler

POEM^*

Useful treatments for fibromyalgia syndrome

Question What treatment modalities are most effective for fibromyalgia syndrome?

Synopsis The optimal method for treating fibromyalgia syndrome is unclear. For this meta-analysis 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 one randomised controlled trial (RCT)), moderate (positive results from one 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 (Elavil), cyclobenzaprine (Flexeril), exercise, cognitive behaviour 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, non-steroidal anti-inflammatory drugs, melatonin, benzodiazepine hypnotics, or trigger point injections.

Bottom line Treatments for fibromyalgia syndrome with the strongest evidence for efficacy are amitriptyline (Elavil), cyclobenzaprine (Flexeril), exercise, cognitive behaviour therapy, patient education, and multidisciplinary therapy.

Level of evidence 1a (see www.infopoems.com/levels.html). Systematic reviews (with homogeneity) of randomised controlled trials.

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Goldenberg DL, Burchhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA 2004;292: 2388-95[Abstract/Free Full Text].

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^* Patient-Oriented Evidence that Matters. See editorial ( BMJ 2002;325: 983[Free Full Text])

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