Therapy target
To improve health-related quality of life while weighing the benefits and risks of the therapy components.
Therapy recommendations
- Therapy initiation as a non-pharmacological intervention, first and foremost aerobic exercise and strength training.
- If the non-pharmacological measures do not lead to success → individualized and the needs of the patient adapted pharmacological therapies (see below):
- Psychological therapies (mainly in the form of cognitive therapies – see “Further therapy” below):
- Pain-related depression
- Anxiety
- Tendency to catastrophize
- Excessively passive or active coping
- Psychopharmacological treatment:
- Severe depression or anxiety
- Pharmacotherapy:
- Severe pain (duloxetine, pregabalin and tramadol (possibly in combination with paracetamol).
- Severe sleep disturbances (low-dose amytriptyline, cyclobenzaprine and pregabalin at night).
- Psychological therapies (mainly in the form of cognitive therapies – see “Further therapy” below):
- In case of response to pharmacotherapy (see overview), a drug discontinuation trial should be considered with the patient after a therapy duration of 6 months at the latest (AWMF guideline FMS).
- Should not be used:
- In cases of severe functional impairment and frequent absence from work, multimodal rehab is recommended.
Note: For patients with fibromyalgia, a psychiatric diagnosis is required to identify and treat the presence of psychiatric comorbidities such as anxiety disorder, post-traumatic stress disorder (PTSD), and/or depressive disorder.
Active ingredients (main indication)
| Active ingredient group | Active ingredients |
| First choice | |
| Anticonvulsant | Pregalabine |
| Selective serotonin reuptake inhibitor | Fluoxetine |
| Paroxetine | |
| Serotonin/norepinephrine reuptake inhibitor | Duloxetine |
| Tricyclic antidepressants | Amitriptyline |
- Most agents in this indication are in off-label use (use outside the indications or group of people for which the drugs are approved by drug authorities)
- Use only for a limited time, consider long-term administration in individual cases.
Supplements (dietary supplements; vital substances)
Suitable dietary supplements should contain the following vital substances:
- Vitamins (vitamin D (calciferols))
- Minerals (magnesium)
- Other vital substances (coenzyme Q10 (CoQ10))
