Rao, Srinivas G, Clauw, Daniel J · Drugs of today (Barcelona, Spain : 1998) · 2004 · DOI
This guideline reviews how fibromyalgia is managed and notes that it shares similarities with other conditions like ME/CFS, irritable bowel syndrome, and chronic headaches. These conditions cause pain that comes from the central nervous system rather than from injured tissue, which means common pain medications like NSAIDs and opioids don't work well. Instead, certain antidepressants, anti-seizure drugs, exercise, and talk therapy tend to be more helpful.
This guideline is relevant to ME/CFS patients because it explicitly acknowledges ME/CFS as one of several overlapping functional somatic syndromes and suggests they may share neurobiological mechanisms. The treatment recommendations—prioritizing neuroactive drugs and behavioral therapies over traditional pain medications—provide evidence-based guidance applicable to ME/CFS management. It also validates the inadequacy of peripheral pain models for understanding these conditions.
This guideline does not prove that fibromyalgia and ME/CFS are identical conditions or that all treatment approaches effective in one are equally effective in the other. It does not provide direct clinical trial data comparing specific medications or therapies, nor does it establish causation for the proposed shared mechanisms—only correlation. The overlap noted does not establish whether these are truly one spectrum of disease or distinct conditions with coincidental similarities.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Rao, Srinivas G & Clauw, Daniel J (2004). The management of fibromyalgia.. Drugs of today (Barcelona, Spain : 1998). https://doi.org/10.1358/dot.2004.40.6.850485
BibTeX
@article{mecfsatlas-rao-2004-management-fibromyalgia,
author = {Rao, Srinivas G and Clauw, Daniel J},
title = {The management of fibromyalgia.},
journal = {Drugs of today (Barcelona, Spain : 1998)},
year = {2004},
doi = {10.1358/dot.2004.40.6.850485},
note = {PubMed: 15349132},
url = {https://www.mecfsatlas.com/evidence/rao-2004-management-fibromyalgia},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/rao-2004-management-fibromyalgia
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