OBJECTIVES: This review was performed to document and analyse the evolution of costs in Fibromyalgia (FM). METHODS: A systematic review (SR) was performed using Mesh terms (Medline 1980-2009). Articles on FM were selected if they presented direct or indirect costs.  Two researchers extracted costs which were divided by type of resource.   Total direct costs were divided by healthcare visits, hospitalization, procedures and drug costs; and, indirect costs in two types:  absenteeism or work with reduced productivity.  Costs were compared and differences were documented.  Trends analysis was performed after converting results to USD$.   RESULTS: Out of 28 citations, 7 articles were included.  Four papers reported costs in USD$, 2 in Euros and 1 in CA$. Costs were reported /patient/year, except for the Canadian 6-month study.  All studies identified total direct costs, disaggregated in subtypes by 6 of them.  Five studies reported total indirect costs; 3/5 reported on absenteeism and on reduced productivity.  Three US studies were performed before 2000, and one in 2005. There was a progression in total direct costs/patient/yr from 1996 to 2005 from USD$2274 to USD$7286 respectively and for total indirect costs, from USD$1010 to USD$2913.  Two European analyses provided similar total direct costs/patient/yr, but did not report on the same indirect costs.  The 6-month results were excluded from the primary trend analysis. A slope of y=1990x and R2=0.83 was obtained, showing a reliable increasing trend.  Including the 6-month analysis (multiplied by 2), results changed to y=1881x, R2=0.64. CONCLUSIONS: This SR and trend analysis documented two major categories and subtypes of costs reported for FM, and detected an increasing trend.   Limitations arose from adjusting indirect costs in two studies and the inclusion of papers from various settings. Further detailed analyses, including costs of comorbidities and premature death, are warranted to establish the full economic impact of FM.