Evidence-Based Complementary and Alternative Medicine / 2013 / Article / Tab 2

Review Article

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.

CanadaGermanyIsrael
Level of evidenceStrength of recommendationLevel of evidenceStrength of recommendationLevel of evidenceStrength of recommendation

Aerobic exerciseIaAIaAIaA
AmitriptylineIaAIaBIaA
Anticonvulsants (gabapentin, pregabalin)IaAIaCIaA
BalneotherapyNo commentIaBIaC
Cognitive-behavioral therapyIaAIaA*IaA
Multicomponent therapyIaAIaAIaA
SNRI (duloxetine, milnacipran)IaAIaB/C**IaA
SSRI IaAIaC    Neither positive nor negative recommendation
TramadolIIaCNo comment***IIaB

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.

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