A 34-year-old female with fibromyalgia is treated. Which intervention is best supported by evidence?

• A. Corticosteroids
• B. Supervised Exercise Program
• C. Hydrocodone (Vicodin)
• D. Refer to Endocrinologist

Answer: (B)

A structured, supervised exercise program has the strongest evidence for benefit in fibromyalgia. Regular, graded aerobic activity (and often some resistance training) improves pain, function, sleep, and mood by enhancing pain modulation and countering deconditioning, with supervision helping patients start safely, progress gradually, and stay adherent. Corticosteroids don’t address the central pain processing involved in fibromyalgia, and evidence shows little to no long-term benefit for this condition. Opioids carry risks of dependence and side effects with limited efficacy in fibromyalgia, so they’re not preferred. Endocrine referral isn’t needed unless there’s a separate endocrine issue; fibromyalgia itself is managed best with nonpharmacologic strategies like exercise, education, and cognitive-behavioral approaches.