Fibromyalgia syndrome: classification, diagnosis, and treatment

Dtsch Arztebl Int. 2009 Jun;106(23):383-91. doi: 10.3238/arztebl.2009.0383. Epub 2009 Jun 5.


Background: This S3 guideline takes positions on currently contentious issues in the classification and treatment of fibromyalgia syndrome (FMS).

Methods: A panel of experts from 10 specialist societies and patients belonging to 2 patient self-help organizations reviewed a total of approximately 8000 publications. Recommendations were developed according to the suggested procedure for S3 guidelines and were then reviewed and approved by the boards of the participating specialist societies. The steering committee ensured that the literature review and the recommendations were kept up to date.

Results: Because this disorder is defined by its symptoms and signs, rather than by any consistently identifiable bodily lesion, the term "fibromyalgia syndrome" is a more appropriate designation for it than "fibromyalgia." FMS is defined by the criteria of the American College of Rheumatology and is classified as a functional somatic syndrome. FMS is diagnosed from the typical constellation of symptoms and by the exclusion of inflammatory and metabolic diseases that could cause the same symptoms. A stepwise treatment approach in which the patient and the physician decide jointly on the treatment options is recommended. The most strongly recommended forms of treatment are aerobic exercise, amitriptyline, cognitive behavioral therapy, and spa therapy.

Conclusions: The guideline recommendations are intended to promote more effective treatment of this disorder.

Keywords: diagnosis; fibromyalgia; functional somatic syndrome; guideline; treatment.

MeSH terms

  • Delivery of Health Care / standards*
  • Fibromyalgia / classification
  • Fibromyalgia / diagnosis*
  • Fibromyalgia / therapy*
  • Humans
  • Practice Guidelines as Topic*
  • Rheumatology / standards*