INTRODUCTION Fibromyalgia is a chronic pain disorder that is often difficult 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 the primary treating clinician and other healthcare providers, including physical medicine, rehabilitation, and mental health specialists [1].

The treatment of fibromyalgia in adults who are not responsive to initial therapies will be reviewed here. The initial treatment and prognosis of fibromyalgia in adults; the pathogenesis, clinical manifestations, diagnosis, and differential diagnosis of fibromyalgia; and fibromyalgia in children and adolescents are discussed separately. (See “Initial treatment of fibromyalgia in adults” 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 TREATMENTTreatment of fibromyalgia is directed at reducing the major symptoms of this disorder, including chronic widespread pain, fatigue, insomnia, and cognitive dysfunction [2-4]. A variety of modalities are employed, using a stepwise approach (table 1). (See “Clinical manifestations and diagnosis of fibromyalgia in adults”.)

Initial therapy — Our initial approach to the treatment of patients with fibromyalgia is discussed in detail separately. (See “Initial treatment of fibromyalgia in adults”.)

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