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Ann Rheum Dis. 2017 Feb;76(2):318-328. doi: 10.1136/annrheumdis-2016-209724. Epub 2016 Jul 4.

EULAR revised recommendations for the management of fibromyalgia.

Author information

1
Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
2
Department of Rheumatology, Cantonal Hospital, Fribourg, Switzerland.
3
ICRCCS Galeazzi Orthopaedic Institute, Milan, Italy.
4
Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany.
5
Department of Psychosomatic Medicine, Technische Universität München, München, Germany.
6
Section of Rheumatology, Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.
7
Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Spine Centre, Stockholm, Sweden.
8
Department of Rheumatology, Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark.
9
Rheumatology Department, CEDOC-NOVA Medical School, UNL, CHLO, Hospital Egas Moniz, Lisbon, Portugal.
10
Hacettepe University Division of Internal Medicine, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.
11
Finnish Institute of Occupational Health, Helsinki, Finland.
12
Patient Representative, Bristol, UK.
13
Mater Misericordiae University Hospital, Dublin, Ireland.
14
Patient Representative, Limassol, Cyprus.
15
Centre de la Douleur, Hôpital Cochin-Hôtel Dieu, Université Paris Descartes, Paris, France.
16
Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.
17
Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.

Abstract

OBJECTIVE:

The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'.

METHODS:

A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.

RESULTS:

2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).

CONCLUSIONS:

These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

KEYWORDS:

Fibromyalgis/Pain Syndromes; Multidisciplinary team-care; Treatment

PMID:
27377815
DOI:
10.1136/annrheumdis-2016-209724
[Indexed for MEDLINE]

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