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Initial treatment of fibromyalgia in adults

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

INTRODUCTION

Fibromyalgia is a chronic pain disorder that is challenging to treat. Effective interventions include a number of nonpharmacologic and pharmacologic therapies that are often provided in combination. Patients with fibromyalgia generally respond best to a multidisciplinary, individualized treatment program that incorporates both clinician and non-clinician providers, including physical medicine, rehabilitation, and mental health specialists [1].

The initial steps in the treatment of fibromyalgia in adults will be reviewed here. The treatment of fibromyalgia in adults who do not respond to initial therapies; the pathogenesis, clinical manifestations, diagnosis, and differential diagnosis of fibromyalgia; and fibromyalgia in children and adolescents are discussed separately. (See "Treatment of fibromyalgia in adults not responsive to initial therapies" and "Pathogenesis of fibromyalgia" and "Clinical manifestations and diagnosis of fibromyalgia in adults" and "Differential diagnosis of fibromyalgia" and "Fibromyalgia in children and adolescents: Clinical manifestations and diagnosis".)

OVERVIEW OF TREATMENT

Treatment of fibromyalgia is directed at reducing the major symptoms of this disorder, including chronic widespread pain, fatigue, insomnia, and cognitive dysfunction [1,2]. A variety of modalities are employed, using a stepwise approach (table 1). (See "Clinical manifestations and diagnosis of fibromyalgia in adults".)

The issue of who should assume primary responsibility for the treatment of patients with fibromyalgia has been controversial. Most specialty groups recommend that the initial management of patients with fibromyalgia can and should be carried out in the primary care setting [1-3]. Ideally, treatment should include an integrated, multidisciplinary nonpharmacologic and pharmacologic approach, but there have been relatively few trials that have formally evaluated such a combined approach to therapy. (See "Treatment of fibromyalgia in adults not responsive to initial therapies", section on 'Multidisciplinary treatment programs'.)

The initial approach to all patients with fibromyalgia should include:

                        

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Literature review current through: Nov 2016. | This topic last updated: Fri Apr 15 00:00:00 GMT+00:00 2016.
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