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Management of fibromyalgia syndrome.

Abstract

CONTEXT

The optimal management of fibromyalgia syndrome (FMS) is unclear and comprehensive evidence-based guidelines have not been reported.

OBJECTIVE

To provide up-to-date evidence-based guidelines for the optimal treatment of FMS. DATA SOURCES, SELECTION, AND EXTRACTION: A search of all human trials (randomized controlled trials and meta-analyses of randomized controlled trials) of FMS was made using Cochrane Collaboration Reviews (1993-2004), MEDLINE (1966-2004), CINAHL (1982-2004), EMBASE (1988-2004), PubMed (1966-2004), Healthstar (1975-2000), Current Contents (2000-2004), Web of Science (1980-2004), PsychInfo (1887-2004), and Science Citation Indexes (1996-2004). The literature review was performed by an interdisciplinary panel, composed of 13 experts in various pain management disciplines, selected by the American Pain Society (APS), and supplemented by selected literature reviews by APS staff members and the Utah Drug Information Service. A total of 505 articles were reviewed.

DATA SYNTHESIS

There are major limitations to the FMS literature, with many treatment trials compromised by short duration and lack of masking. There are no medical therapies that have been specifically approved by the US Food and Drug Administration for management of FMS. Nonetheless, current evidence suggests efficacy of low-dose tricyclic antidepressants, cardiovascular exercise, cognitive behavioral therapy, and patient education. A number of other commonly used FMS therapies, such as trigger point injections, have not been adequately evaluated.

CONCLUSIONS

Despite the chronicity and complexity of FMS, there are pharmacological and nonpharmacological interventions available that have clinical benefit. Based on current evidence, a stepwise program emphasizing education, certain medications, exercise, cognitive therapy, or all 4 should be recommended.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Rheumatology, Newton-Wellesley Hospital, Newton, Mass 02462, USA. dgoldenb@massmed.org

    ,

    Source

    JAMA 292:19 2004 Nov 17 pg 2388-95

    MeSH

    Analgesics
    Antidepressive Agents
    Cognitive Behavioral Therapy
    Exercise
    Fibromyalgia
    Humans
    Pain Measurement
    Patient Education as Topic
    Physical Therapy Modalities
    Stress, Psychological

    Pub Type(s)

    Guideline
    Journal Article
    Practice Guideline
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    15547167

    Citation

    Goldenberg, Don L., et al. "Management of Fibromyalgia Syndrome." JAMA, vol. 292, no. 19, 2004, pp. 2388-95.
    Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004;292(19):2388-95.
    Goldenberg, D. L., Burckhardt, C., & Crofford, L. (2004). Management of fibromyalgia syndrome. JAMA, 292(19), pp. 2388-95.
    Goldenberg DL, Burckhardt C, Crofford L. Management of Fibromyalgia Syndrome. JAMA. 2004 Nov 17;292(19):2388-95. PubMed PMID: 15547167.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Management of fibromyalgia syndrome. AU - Goldenberg,Don L, AU - Burckhardt,Carol, AU - Crofford,Leslie, PY - 2004/11/18/pubmed PY - 2004/12/16/medline PY - 2004/11/18/entrez SP - 2388 EP - 95 JF - JAMA JO - JAMA VL - 292 IS - 19 N2 - CONTEXT: The optimal management of fibromyalgia syndrome (FMS) is unclear and comprehensive evidence-based guidelines have not been reported. OBJECTIVE: To provide up-to-date evidence-based guidelines for the optimal treatment of FMS. DATA SOURCES, SELECTION, AND EXTRACTION: A search of all human trials (randomized controlled trials and meta-analyses of randomized controlled trials) of FMS was made using Cochrane Collaboration Reviews (1993-2004), MEDLINE (1966-2004), CINAHL (1982-2004), EMBASE (1988-2004), PubMed (1966-2004), Healthstar (1975-2000), Current Contents (2000-2004), Web of Science (1980-2004), PsychInfo (1887-2004), and Science Citation Indexes (1996-2004). The literature review was performed by an interdisciplinary panel, composed of 13 experts in various pain management disciplines, selected by the American Pain Society (APS), and supplemented by selected literature reviews by APS staff members and the Utah Drug Information Service. A total of 505 articles were reviewed. DATA SYNTHESIS: There are major limitations to the FMS literature, with many treatment trials compromised by short duration and lack of masking. There are no medical therapies that have been specifically approved by the US Food and Drug Administration for management of FMS. Nonetheless, current evidence suggests efficacy of low-dose tricyclic antidepressants, cardiovascular exercise, cognitive behavioral therapy, and patient education. A number of other commonly used FMS therapies, such as trigger point injections, have not been adequately evaluated. CONCLUSIONS: Despite the chronicity and complexity of FMS, there are pharmacological and nonpharmacological interventions available that have clinical benefit. Based on current evidence, a stepwise program emphasizing education, certain medications, exercise, cognitive therapy, or all 4 should be recommended. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/15547167/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.292.19.2388 DB - PRIME DP - Unbound Medicine ER -