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Commentary on the EULAR recommendations for the management of fibromyalgia

Nature Clinical Practice Rheumatology volume 4, pages 392–393 (2008)Cite this article

The EULAR evidence-based recommendations for the management of fibromyalgia syndrome offer an excellent overview of the studies in fibromyalgia published to date.1 The authors painstakingly evaluated all the clinical trials performed in fibromyalgia, and, using only those studies of sufficient quality, developed a series of evidence-based recommendations for the assessment and treatment of this condition. Their recommendations concerning pharmacological interventions are nicely augmented and complemented by sensible expert opinion on the overall therapeutic approach to fibromyalgia and the use of nonpharmacological treatments. The overall message of the manuscript is appropriate and well described: fibromyalgia is an eminently treatable disease, and a multidisciplinary approach that utilizes both pharmacological and nonpharmacological therapies is optimal for most patients.

However, such brief, evidence-based reviews often fail to answer the question “Why do these treatments work?” This question is particularly important in a condition such as fibromyalgia, which is surrounded by misinformation and confusion amongst both patients and healthcare providers. The problem of misinformation was inadvertently magnified in this particular article by the authors' use of terms that might lead to continued misunderstanding of fibromyalgia and related conditions. For example, the authors state that “antidepressants (such as) amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide and pirlindole, reduce pain and often improve function therefore they should be considered for the treatment of fibromyalgia.” As the authors are undoubtedly aware, these drugs have beneficial effects in fibromyalgia independent of their antidepressant effects—indeed, the drugs are not primarily acting as antidepressants in this setting—so it would have been helpful to point out that the term “antidepressants” is misleading.

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  1. 24 Frank Lloyd Wright Drive, P.O. Box 385, Ann Arbor, MI 48106, USA dclauw@med.umich.edu

Authors and Affiliations

  1. DJ Clauw is Professor of Rheumatology and Associate Dean for Clinical and Translational Research at the University of Michigan, Ann Arbor, MI, USA.,

    Daniel J Clauw

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DJ Clauw has acted as a consultant for Cypress, Forest, Lilly, Pfizer and Wyeth.

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Clauw, D. Commentary on the EULAR recommendations for the management of fibromyalgia. Nat Rev Rheumatol 4, 392–393 (2008). https://doi.org/10.1038/ncprheum0840

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