OBJECTIVES: Fibromyalgia is a disorder characterized by widespread chronic musculoskeletal pain.  This study aims to understand the treatment patterns associated with currently available and commonly used medications in the management of fibromyalgia. METHODS: This retrospective study used the MarketScan claim database to identify patients who had a first fibromyalgia diagnosis code (ICD-9-CM: 729.1) in 2009-2011 with a repeat diagnosis within a year; were at least 18 years old; and had continuous enrollment for ≥12 months before and after the date of first diagnosis, i.e. the index date. The pain treatments assessed were: anticonvulsants (pregabalin, gabapentin), antidepressants (amitriptyline, cyclobenzaprine, venlafaxine, duloxetine, milnacipran), and opioid (tramadol). Adherence was evaluated using percent of days covered (PDC) and categorized into low (<50%), medium (50%-80%), and high (≥80%). The 1-year discontinuation (defined as the first drug supply gap ≥90 days) rate was estimated using Kaplan-Meier curve.  RESULTS: A total of 240,144 patients met the inclusion criteria; 68% were female and the study sample mean (SD) age was 48 (13.8) years. Only 31% (N=74,738) of the patients initiated a treatment of interest within a year after the index date. The 3 most frequently dispensed ones were cyclobenaprine (27.4%), tramadol (17.9%), and gabapentin (16.3%). Duloxetine, pregabalin, and milnacipran accounted for 13.6%, 8.9%, and 3.8% of treated patients respectively. Adherence was suboptimal for all of these treatments: mean PDCs (% with high adherence) were 59% (39%), 47% (24%), 44% (22%), 43% (21%), 27% (9%), and 20% (5%) for duloxetine, pregabalin, gabapentin, milnacipran, tramadol, and cyclobenaprine, respectively;  and the corresponding 1-year discontinuation rates were 52%, 65%, 67%, 72%, 80%, and 90%, respectively. CONCLUSIONS: The majority of patients diagnosed with fibromyalgia were not treated with the assessed therapies in this study cohort.  Adherence and persistence with the current pain medications were sub-optimal.