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We screened <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>ub<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>ed, <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>mbase and the <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ochrane <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>ibrary for <jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content> articles from 1990 to <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>eptember 2012 to analyse randomized controlled trials comparing pharmacologic or non\u2010pharmacologic treatments to placebo or sham. Papers including assessments of at least 2 of the 6 main <jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content> symptom domains \u2013 pain, sleep disturbance, fatigue, affective symptoms (depression\/anxiety), functional deficit and cognitive impairment \u2013 were selected for analysis. Studies exploring pharmacologic approaches (<jats:italic>n<\/jats:italic>\u2009=\u200921) were mainly dedicated to treating a small number of dimensions, mostly pain. They were of good quality but were not prospectively designed to simultaneously document efficacy for the management of multiple core <jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content> symptom domains. Only amitriptyline demonstrated a significant effect on as many as three core <jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content> symptoms, but it exhibited many adverse effects and was subject to early tachyphylaxis. Studies involving non\u2010pharmacologic approaches (<jats:italic>n<\/jats:italic>\u2009=\u200964) were typically of poorer quality but were more often dedicated to multidimensional targets. Pool therapy demonstrated significant effects on five symptom domains, repetitive transcranial magnetic stimulation on four domains, balneotherapy on three domains and exercise, cognitive behaviour therapy and massage on two domains each. Differences between pharmacologic and non\u2010pharmacologic approaches may be related to different modes of action, tolerability profiles and study designs. Very few drugs in well\u2010designed clinical trials have demonstrated significant relief for multiple <jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content> symptom domains, whereas non\u2010pharmacologic treatments with weaker study designs have demonstrated multidimensional effects. Future therapeutic trials for <jats:styled-content style=\"fixed-case\">FM<\/jats:styled-content> should prospectively examine each of the core domains and should attempt to combine pharmacologic and non\u2010pharmacologic therapies in well\u2010designed clinical trials.<\/jats:p>","DOI":"10.1002\/ejp.564","type":"journal-article","created":{"date-parts":[[2014,8,19]],"date-time":"2014-08-19T09:33:49Z","timestamp":1408440829000},"page":"1067-1080","source":"Crossref","is-referenced-by-count":89,"title":["More ubiquitous effects from non\u2010pharmacologic than from pharmacologic treatments for fibromyalgia syndrome: A meta\u2010analysis examining six core symptoms"],"prefix":"10.1002","volume":"18","author":[{"given":"S.","family":"Perrot","sequence":"first","affiliation":[{"name":"Service de M\u00e9decine Interne et Th\u00e9rapeutique H\u00f4tel Dieu Paris Descartes University, INSERM U 987  France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.J.","family":"Russell","sequence":"additional","affiliation":[{"name":"Fibromyalgia Research and Consulting Arthritis and Osteoporosis Center of South Texas  San Antonio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,8,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.148.12.1721"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/acm.2008.0410"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(03)00139-8"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-003-0371-7"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2009.06.021"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/eujp.1999.0148"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20119"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-006-0237-x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3233\/BMR-2006-19405"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.27559"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(01)01089-0"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.20485"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2005.06.031"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2008.03.013"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.21693"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keh111"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(97)00351-3"},{"key":"e_1_2_9_19_1","first-page":"27","article-title":"An internet survey of 2596 people with fibromyalgia","volume":"8","author":"Bennett R.M.","year":"2007","journal-title":"BMC Musculoskelet Disord"},{"key":"e_1_2_9_20_1","first-page":"389","article-title":"The effectiveness of chiropractic management of fibromyalgia patients: A pilot study","volume":"20","author":"Blunt K.L.","year":"1997","journal-title":"J Manipulative Physiol Ther"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.090884"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1090-3801(99)90050-2"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e31802b4f80"},{"key":"e_1_2_9_24_1","volume-title":"Guideline for the Management of Fibromyalgia Syndrome Pain in Adults and Children. 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