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The April 16 issue of [i]JAMA[/i] included a kind of a review on fibromyalgia, which was actually based on a conference that took place at the Medicine Grand Rounds at Beth Israel Deaconess Medical Center, Boston, Massachusetts, on October 2012 [1]. The article starts with a case history of a 64-year-old woman with ongoing, long-term, diffuse muscle pain and fatigue. Interestingly enough, the patient’s testimony on how she sees her health condition was given as well. Her wish was to find a treatment regimen that would allow her to be more functional while avoiding adverse effects. The rest of the manuscript addresses the topics of diagnosis, epidemiology, pathophysiology and therapeutic options (both pharmacological and non-pharmacological). Treatment advices were: all patients should have a good therapeutic trial of a low-dose tricyclic compound; patients with co-morbid depression or fatigue should next try a serotonin norepinephrine reuptake inhibitor; non-steroidal anti-inflammatory drugs and acetaminophen can be used to treat co-morbid ‘peripheral pain generators’. Complementary and alternative therapies have been less well studied but show promise. The authors also stressed the need for patient’s education on the disease and counseling on the role of exercise and cognitive behavioral techniques.


  • Amos Pines
    Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel


  1. Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014;311:1547-55.
  2. Blümel JE, Palacios S, Legorreta D, Vallejo MS, Sarra S. Is fibromyalgia part of the climacteric syndrome? Maturitas 2012;73:87-93.
  3. Häuser W, Zimmer C, Felde E, Köllner V. What are the key symptoms of fibromyalgia? Results of a survey of the German Fibromyalgia Association. Schmerz 2008;22:17683 [article in German]
  4. Meriggiola MC, Nanni M, Bachiocco V, Vodo S, Aloisi AM. Menopause affects pain depending on pain type and characteristics. Menopause 2012;19:517-23.
  5. Chlebowski RT, Cirillo DJ, Eaton CB, et al. Estrogen alone and joint symptoms in the Womens Health Initiative randomized trial. Menopause 2013;20:600-8
  6. Laroche F, Coste J, Medkour T, et al. Classification of and risk factors for estrogen deprivation pain syndromes related to aromatase inhibitor treatments in women with breast cancer: a prospective multicenter cohort study. J Pain 2014;15:293-303.
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