CLINICAL QUESTION: What treatment modalities are most effective for fibromyalgia syndrome?
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 biofeed-back. 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.
