Why apply Multimodal therapy?

Chronic widespread pain and tenderness are the defining features of FM; however, FM is a complex condition and many patients experience a range of other symptoms.

No single therapy for FM targets every symptom. The multifaceted nature of FM suggests that a variety of approaches may be necessary in order to achieve optimal outcomes in patients with FM.

The third pillar of the FM framework for primary care is to apply multimodal therapy. It involves using pharmacotherapy as appropriate, treating comorbid conditions, and incorporating nonpharmacological therapies into the patient's treatment plan.

Please note that LYRICA (pregabalin) is approved for the management of FM. Although patients with FM may present with a number of symptoms, clinical data support the use of LYRICA for FM pain but not for any other ancillary symptoms.

Symptoms of FM3,4

  • Chronic widespread pain

  • Tenderness

  • Fatigue

  • Sleep disturbances

  • Mood disturbances

  • Morning stiffness

Key points for applying multimodal therapy1

  • Be proactive and prepared: know your patient, your team,
    and your community resources

  • Maximize the effectiveness of pharmacotherapy

  • Encourage nonpharmacological therapies for
    FM management

  • Offer strategies to improve adherence to physical activity2

  • Provide sleep hygiene advice4

Importantly, this multimodal approach to FM
management requires patients to be active
participants in their care.


1. Goldenberg DL. Clinical Management of Fibromyalgia. 1st ed. West Islip, NY: Professional Communications, Inc; 2009.

2. McCarberg BH. Fibromyalgia management for the primary care provider. In: McCarberg BH, Clauw DJ, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:152-158.

3. Wolfe F. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990;33(2):160-172.

4. Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol. 2005;32(suppl 75):6-21.