• Winfried Häuser, Serge Perrot, Daniel J Clauw, and Mary-Ann Fitzcharles.
• Department Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany; Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich. Electronic address: whaeuser@klinikum-saarbruecken.de.
• J Pain. 2018 Feb 1; 19 (2): 125-134.

AbstractThe heterogeneity of the clinical presentation and the pathophysiologic mechanisms associated with fibromyalgia (FM), and the modest results on average for any therapy, call for a more individualized management strategy. Individualized treatment can be on the basis of subgrouping of patients according to associated conditions (mental health problems, chronic overlapping pain conditions, other somatic diseases) or on disease severity. Categorizing FM as mild, moderate, or severe can be on the basis of clinical assessment (eg, degree of daily functioning) or on questionnaires. Shared decision-making regarding treatment options can be directed according to patient preferences, comorbidities, and availability in various health care settings. The European League Against Rheumatism guidelines recommend a tailored approach directed by FM key symptoms (pain, sleep disorders, fatigue, depression, disability), whereas the German guidelines recommend management tailored to disease severity, with mild disease not requiring any specific treatment, and more severe disease requiring multicomponent therapy (combination of drug treatment with aerobic exercise and psychological treatments). When indicated, treatments should follow a stepwise approach beginning with easily available therapies such as aerobic exercise and amitriptyline. Successful application of a tailored treatment approach that is informed by individual patient characteristics should improve outcome of FM.Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

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