Condition

Fibromyalgia

Chronic widespread musculoskeletal pain

160M
People Affected
26
Active Trials
3.2M
New Cases/Year
1,000
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Cognitive Behavioral Therapy (CBT)
72% Effectiveness• 88% Confidence• 95% Safety• 55 trials• 10K participants
HIGH EvidenceExcellent ValueDose: 1-hour sessions, 8-12 weeks
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

8-12 weeks

Duration

8-12 weekly sessions, then maintenance

Response Rate

55%

Remission Rate

3%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

9

Common Side Effects:

Initial emotional discomfort: 20%
Time commitment: 15%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,500

Side Effects

$50

Total Annual

$1,550

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.09

ICER

$15,000/QALY

Cost per Remission

$51,666.67

Cost per Responder

$2,818.18

Treatment Outcomes
Primary Outcomes
Pain Intensity7.0 (NRS 0-10)
-21.4% (-1.5 points)
Fibromyalgia Impact (FIQ-R)65.0 (FIQ-R 0-100)
-19.2% (-12.5 points)
Depression Severity (PHQ-9)16.0 (PHQ-9 0-27, moderate-severe depression)
-31.3% (-5.0 points)
Fatigue Severity (FSS)5.5 (FSS 1-7)
-14.5% (-0.8 points)
Sleep Quality (PSQI)13.0 (PSQI 0-21, poor sleep quality)
-23.1% (-3.0 points)
Secondary Benefits
Anxiety Severity (GAD-7)12.0 (GAD-7 0-21, moderate anxiety)
-29.2% (-3.5 points)
Physical Functioning (SF-36)30.0 (SF-36 PF 0-100)
+33.3% (+10.0 points)
Health-Related Quality of Life (SF-36 Mental Health)40.0 (SF-36 MH 0-100)
+37.5% (+15.0 points)
Common Side Effects
Initial emotional discomfort
+20%
Time commitment
+15%
2
Aerobic Exercise
70% Effectiveness• 90% Confidence• 95% Safety• 74 trials• 15K participants
HIGH EvidenceExcellent ValueDose: 30-60 minutes, 3-5 times per week
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

6-12 weeks

Duration

Lifetime maintenance

Response Rate

50%

Remission Rate

3%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

12

Common Side Effects:

Temporary muscle soreness: 40%
Initial fatigue: 20%
Low risk of injury (e.g., sprains): 5%

Annual Cost of Care

Drug Cost

$0

Monitoring

$300

Side Effects

$50

Total Annual

$350

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.08

ICER

$5,000/QALY

Cost per Remission

$11,666.67

Cost per Responder

$700

Treatment Outcomes
Primary Outcomes
Pain Intensity (NRS 0-10)7/10
-21.4% (-1.5 points)
Fatigue Severity Scale (FSS)55/63
-14.5% (-8 points)
Fibromyalgia Impact Questionnaire (FIQ)65/100
-15.4% (-10 points)
Health Assessment Questionnaire-Disability Index (HAQ-DI)2.0/3.0
-15% (-0.3 points)
Secondary Benefits
Pittsburgh Sleep Quality Index (PSQI)14/21
-17.9% (-2.5 points)
Beck Depression Inventory-II (BDI-II)25/63
-16% (-4 points)
SF-36 Physical Component Summary (PCS)30/100
+10% (+3 points)
Common Side Effects
Temporary muscle soreness
+40%
Initial fatigue
+20%
Low risk of injury (e.g., sprains)
+5%
3
Duloxetine
65% Effectiveness• 85% Confidence• 59% Safety• 32 trials• 10K participants
HIGH EvidenceExcellent ValueDose: 30-60mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
59
DangerousModerateSafe

Time to Effect

1-4 weeks

Duration

Long-term

Response Rate

40%

Remission Rate

5%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

7

Common Side Effects:

Nausea: 30%
Dry mouth: 25%
Dizziness: 20%
Somnolence: 15%
Constipation: 15%

Annual Cost of Care

Drug Cost

$480

Monitoring

$500

Side Effects

$150

Total Annual

$1,130

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.04

ICER

$48,000/QALY

Cost per Remission

$22,600

Cost per Responder

$2,825

Treatment Outcomes
Primary Outcomes
Pain Severity7.2 on 0-10 Numeric Rating Scale
-25% (-1.8 points)
Fibromyalgia Impact Questionnaire (FIQ-R Total Score)61 on 0-100 FIQ-R scale
-13.1% (-8 points)
Fatigue Severity78 on 20-100 Multidimensional Fatigue Inventory-20 scale
-11.5% (-9 points)
Secondary Benefits
Sleep Quality15 on 0-21 Pittsburgh Sleep Quality Index
-20% (-3 points)
Depressive Symptoms22 on 0-52 Hamilton Depression Rating Scale-17
-27.3% (-6 points)
Physical Function32 on 0-100 SF-36 Physical Component Summary
+12.5% (+4 points)
Common Side Effects
Nausea
+30%
Dry mouth
+25%
Dizziness
+20%

Clinical Trial Phases:

Phase 3Phase 4
4
Pregabalin
65% Effectiveness• 85% Confidence• 58% Safety• 57 trials• 10K participants
HIGH EvidenceGood ValueDose: 150-450mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
58
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Long-term

Response Rate

40%

Remission Rate

5%

Number Needed to Treat (NNT)

9

Number Needed to Harm (NNH)

8

Common Side Effects:

Dizziness: 30%
Somnolence: 25%
Dry mouth: 15%
Weight gain: 10%
Peripheral edema: 10%

Annual Cost of Care

Drug Cost

$720

Monitoring

$500

Side Effects

$150

Total Annual

$1,370

Cost-Effectiveness

GOOD

QALYs Gained

0.04

ICER

$60,000/QALY

Cost per Remission

$27,400

Cost per Responder

$3,425

Treatment Outcomes
Primary Outcomes
Pain Intensity (0-10 NRS)7.0 points
-30% (-2.1 points)
Fibromyalgia Impact Questionnaire (FIQ) Total Score (0-100 scale)65 points
-20% (-13.0 points)
Sleep Disturbance (0-10 scale, higher is worse)7.5 points
-22% (-1.65 points)
Fatigue Severity (0-10 scale)7.0 points
-18% (-1.26 points)
Secondary Benefits
SF-36 Physical Component Summary (PCS) Score30 points
+10% (+3.0 points)
HADS-Anxiety Score (0-21 scale)12 points
-15% (-1.8 points)
HADS-Depression Score (0-21 scale)11 points
-10% (-1.1 points)
Common Side Effects
Dizziness
+30%
Somnolence
+25%
Dry mouth
+15%

Clinical Trial Phases:

Phase 3Phase 4
5
Milnacipran
63% Effectiveness• 80% Confidence• 59% Safety• 28 trials• 5K participants
HIGH EvidenceGood ValueDose: 50-100mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
59
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Long-term

Response Rate

35%

Remission Rate

4%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

8

Common Side Effects:

Nausea: 40%
Headache: 20%
Constipation: 15%
Dizziness: 15%
Insomnia: 15%
Hyperhidrosis (sweating): 15%

Annual Cost of Care

Drug Cost

$900

Monitoring

$500

Side Effects

$150

Total Annual

$1,550

Cost-Effectiveness

GOOD

QALYs Gained

0.035

ICER

$65,000/QALY

Cost per Remission

$38,750

Cost per Responder

$4,428.57

Treatment Outcomes
Primary Outcomes
Pain Intensity (NRS)6.5/10
-25% (-1.6 points)
Fibromyalgia Impact Questionnaire (FIQ) Total Score60/80
-18% (-10.8 points)
Fatigue (Visual Analog Scale)70/100 mm
-10% (-7 mm)
Secondary Benefits
Sleep Quality (PSQI Score)15/21
-10% (-1.5 points)
SF-36 Physical Component Summary (PCS)30/100
+10% (+3 points)
Beck Depression Inventory-II (BDI-II) Score25/63
-20% (-5 points)
Common Side Effects
Nausea
+40%
Headache
+20%
Constipation
+15%

Clinical Trial Phases:

Phase 3Phase 4
6
Amitriptyline
60% Effectiveness• 75% Confidence• 58% Safety• 10 trials• 5K participants
MODERATE EvidenceExcellent ValueDose: 10-50mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
58
DangerousModerateSafe

Time to Effect

2-6 weeks

Duration

Long-term

Response Rate

35%

Remission Rate

3%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

4

Common Side Effects:

Dry mouth: 50%
Sedation: 40%
Constipation: 25%
Dizziness: 20%
Weight gain: 15%

Annual Cost of Care

Drug Cost

$180

Monitoring

$500

Side Effects

$150

Total Annual

$830

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

ICER

$20,000/QALY

Cost per Remission

$27,666.67

Cost per Responder

$2,371.43

Treatment Outcomes
Primary Outcomes
Pain Intensity (NRS 0-10)6.5/10
-25% (-1.6 points)
Fibromyalgia Impact Questionnaire (FIQ) Total Score55/80
-18% (-9.9 points)
Sleep Disturbance (NRS 0-10)7.0/10
-30% (-2.1 points)
Secondary Benefits
Fatigue Severity (NRS 0-10)7.5/10
-12% (-0.9 points)
SF-36 Physical Component Summary (PCS) Score35/100
+8.6% (+3.0 points)
Depressive Symptoms (BDI-II Score)25/63
-25% (-6.3 points)
Common Side Effects
Dry mouth
+50%
Sedation
+40%
Constipation
+25%

Clinical Trial Phases:

Phase 4
7
Gabapentin
58% Effectiveness• 70% Confidence• 58% Safety• 10 trials• 3K participants
MODERATE EvidenceExcellent ValueDose: 900-2400mg daily
Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
58
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Long-term

Response Rate

30%

Remission Rate

3%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

8

Common Side Effects:

Dizziness: 25%
Somnolence: 20%
Peripheral edema: 10%
Weight gain: 10%

Annual Cost of Care

Drug Cost

$360

Monitoring

$500

Side Effects

$150

Total Annual

$1,010

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

ICER

$25,000/QALY

Cost per Remission

$33,666.67

Cost per Responder

$3,366.67

Treatment Outcomes
Primary Outcomes
Pain Intensity6.5/10 (NPRS)
-23% (-1.5 points)
Sleep Disturbance14.5/21 (PSQI)
-17% (-2.5 points)
Fatigue Severity55/84 (FIS)
-13% (-7 points)
Secondary Benefits
Fibromyalgia Impact65/100 (FIQ-R)
-18% (-12 points)
Health-Related Quality of Life (Physical Component)35/100 (SF-36 PCS)
+14% (+5 points)
Common Side Effects
Dizziness
+25%
Somnolence
+20%
Peripheral edema
+10%

Clinical Trial Phases:

Phase 4