Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies

Table 2

Comparison of major positive treatment recommendations of the three guidelines.

	Canada		Germany		Israel
	Level of evidence	Strength of recommendation	Level of evidence	Strength of recommendation	Level of evidence	Strength of recommendation
Aerobic exercise	Ia	A	Ia	A	Ia	A
Amitriptyline	Ia	A	Ia	B	Ia	A
Anticonvulsants (gabapentin, pregabalin)	Ia	A	Ia	C	Ia	A
Balneotherapy	No comment		Ia	B	Ia	C
Cognitive-behavioral therapy	Ia	A	Ia	A*	Ia	A
Multicomponent therapy	Ia	A	Ia	A	Ia	A
SNRI (duloxetine, milnacipran)	Ia	A	Ia	B/C**	Ia	A
SSRI	Ia	A	Ia	C	Neither positive nor negative recommendation
Tramadol	IIa	C	No comment***		IIa	B

∗If combined with exercise; **B in case of a comorbid depressive or generalized anxiety disorder; C in case without depressive or generalized anxiety disorder; ***In case of only one RCT with positive results, no recommendation was given.
SNRI: serotonin noradrenaline reuptake inhibitors; SSRI: serotonin reuptake inhibitors; TCA: tricyclic antidepressant.
A: strong recommendation: the intervention should be offered to most of the patients.
B: recommendation: the intervention may be offered to the majority of patients. the intervention may not be offered to a substantial minority of the patients.
C: open recommendation: the intervention can be offered to a minority patients.