Fibromyalgia (FM) is a common syndrome characterised by widespread pain and at 
least 11/18 painful tender points that requires multimodal pharmacological 
treatment also combined with non-pharmacological therapy. Various drugs 
currently are available to control the complex and different symptoms reported 
by patients. Only three drugs (duloxetine, milnacipram, pregabalin) are approved 
by the American Food and Drug Administration (FDA) and none by the European 
Medicines Agency (EMEA), consequently, off-label use is habitual in Europe. Most 
of the drugs improve only one or two symptoms; no drug capable of overall 
symptom control is yet available. Furthermore, different classes of drugs with 
different mechanisms of action are used off-label, including tricyclic 
antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), 
serotonin norepinephrine reuptake inhibitors (SNRIs), opioids, non-steroidal 
anti-inflammatory drugs (NSAIDs), growth hormone, corticosteroids and sedative 
hypnotics. As no single drug fully manages FM symptoms, multicomponent therapy 
should be used from the beginning. Various pharmacological treatments have been 
used to treat FM with inconclusive results, and gradually increasing low doses 
is suggested in order to maximise efficacy. The best treatment should be 
individualised and combined with patient education and non-pharmacological 
therapy.