Fibromyalgia treatment guidelines from EULAR

Clinical Question

What are the preferred approaches to treating patients with fibromyalgia?

Bottom Line

Antidepressants, pramipexole (Mirapex and Sifrol), pregabalin (Lyrica), tramadol (Ultram), tropisetron (Navoban), and heated pool treatments have been shown to have short-term effectiveness in the treatment of fibromyalgia pain. (LOE = 1a-)


Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 2008;7:536-541.  [PMID:17644548]




These guidelines were developed by EULAR, a multidisciplinary task force of representatives from 11 European countries. To prepare this guideline, the group performed a comprehensive search and evaluation of the available medical literature, using a consensus system. Strong evidence was available only for drug therapy. Based on a good response in several small trials, the group recommends heated pool treatments with or without exercise (strength of evidence: B). Tramadol, antidepressants, tropisetron, pramipexole, and pregabalin are effective for reducing pain, and antidepressants can improve function (strength of evidence: A). There is only weak evidence supporting the use of tailored exercise programs, cognitive behavioral therapy, acetaminophen, or weak opioids. The group recommends against the use of corticosteroids or strong opioids. No research has evaluated the relative benefits of treatment, and most of the studies are short in duration, creating the possibility of a potent placebo effect.