| Abstract [eng] |
Introduction. Fibromyalgia is a chronic pain syndrome frequently accompanied by fatigue, sleep disturbance, cognitive complaints, and psychological distress, resulting in substantial impairment in daily functioning and quality of life. Aim. To summarize evidence-based management strategies for fibromyalgia using European Alliance of Associations for Rheumatology (EULAR) recommendations, a PubMed-based literature review, and Cochrane evidence syntheses. Also, to outline the clinical relevance of the 2025 French National Authority for Health (HAS) guideline and the newly Food and Drug Administration (FDA) approved cyclobenzaprine hydrochloride sublingual tablets (Tonmya). Methods. EULAR recommendations were reviewed. A structured narrative synthesis of recent evidence indexed in PubMed was performed, focusing on adult fibromyalgia management. Key findings from Cochrane Review on pharmacological and non-pharmacological interventions were summarized. The 2025 HAS guideline was incorporated, and information on FDA approval of cyclobenzaprine hydrochloride sublingual tablets was included. Results. EULAR places non-pharmacological interventions – especially graded, regular physical activity-at the core of management, recommending pharmacotherapy only as and individualized adjunct based on symptom profile. Cochrane and contemporary meta-analytic evidence suggests that duloxetine, pregabalin, and milnacipran may benefit a subset of patients, yet average effects are modest and tolerability can limit long-term use. Combination pharmacotherapy lacks robust evidence for routine implementation. The HAS guideline emphasizes practical care pathways, patient education, and treatment coordination within routine clinical settings. In 2025, the FDA approved cyclobenzaprine hydrochloride sublingual tablets for adult fibromyalgia, marking a notable new pharmacological option. Conclusions. The most consistent evidence supports a multimodal, individualized approach centered on non-pharmacological strategies (exercise, education, and psychological interventions), with medications used selectively as add-on therapy. The HAS 2025 recommendations and the FDA approval of cyclobenzaprine hydrochloride sublingual tablets highlight ongoing evolution in fibromyalgia care and the need for updated, pathway-oriented implementation in clinical practice. |
