OBJECTIVES: To review the real world evidence in fibromyalgia from last five years identifying prevalent pharmacological treatment options across US and costs associated for management of the disease. METHODS: Embase® and Medline databases were searched between January 2011 and December 2015. Registries and observational studies in fibromyalgia population published as full text journal articles in English were included by two independent reviewers with discrepancies reconciled by a third independent reviewer. Pharmacological treatment pattern was captured along with costs of disease management if reported across the included evidence. RESULTS: Out of 477 studies retrieved from biomedical databases, only 11 met the inclusion criteria. Average patient population was 80% women with mean age of 50 years. In a general US wide study, 68.7% used opioid, 43.3% used non-opioid painkillers, whereas only 11.3% used pregabalin for treating FM symptoms. Duloxetine (8 Studies) and Pregabalin (9 Studies) were found to be commonly prescribed for managing FM symptoms in the US, with direct total treatment costs per patient ranging between $1275-$25192 and $1231-$20809.9, respectively, for the 12 month treatment and follow-up period. Dosing and polypharmacy (four studies) largely affected the adherence and cost of the treatment among FM patients. More severe disease as per Fibromyalgia Impact Questionnaire (FIQ) score was associated with higher costs of symptom management. Milnacipran for FM was approved by US FDA in 2009. However, only conference abstracts of a pregnancy registry evaluating its safety profile were retrieved and excluded due to limited information as per inclusion criteria. CONCLUSIONS: FM specific approved pharmacological treatments and costs were identified from US real world setting. Cost data for Milnacipran was lacking. More observational studies are needed for better understanding the clinical fibromyalgia management and associated costs.