Are complex therapies required as pharmacological treatments of fibromyalgia?

Fibromyalgia (FM), a chronic pain condition with many auxiliary symptoms and co-morbidities, is estimated to affect 2–4% of the general population. Current management involves medications that remain largely empiric, which many patients may find either insufficient to control their symptoms or difficult to tolerate. The lack of a complete understanding of the pathophysiological processes underlying this condition limits the ability to provide rationally designed, mechanistically based treatments. As a consequence, treatment is often directed towards individual symptoms rather than management of the condition. This has resulted in limited success of clinical trials in FM, which may be related to an apparent reductionist approach to their design for the evaluation of a complex condition. The complexity of FM suggests that, to date, monotherapy will not adequately address the condition.