Clinical recommendation	Evidence rating	References
A combination of the 2010 diagnostic criteria from the American College of Rheumatology, symptom scores, and presence of chronic widespread pain with fatigue and sleep symptoms should be used to diagnose fibromyalgia.	C	1, 4, 5
Patients with fibromyalgia should be evaluated for comorbid functional pain syndromes and mood disorders.	C	7–12
Aerobic exercise (20 to 30 minutes two or three days per week) improves pain symptoms and fatigue in patients with fibromyalgia.	A	17, 18
Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and cyclobenzaprine (Flexeril) have the strongest evidence of benefit for improvements in pain, sleep, and quality of life in patients with fibromyalgia. Tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors improve symptoms of fatigue.	A	22, 23, 25
Antiepileptics may provide benefits for pain, sleep, and quality of life in patients with fibromyalgia.	C	24