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EULAR: Updated recommendations for fibromyalgia

A woman deep in thought in the shadowThe European League Against Rheumatism (EULAR) has published updated recommendations on the management of fibromyalgia. The detailed recommendations can be found in the Annals of the Rheumatic Diseases.

Fibromyalgia is a condition characterized primarily by chronic widespread pain (CWP) in the muscles, ligaments and tendons, and a heightened sensitivity to touch resulting in pain that can last for months.

Common signs and symptoms of fibromyalgia include:

  • Depression
  • Mood changes
  • Numbness or tingling sensations in the hands and feet
  • Concentration problems
  • Pain in the chest
  • Dry eyes, skin and mouth
  • Painful menstrual periods
  • Dizziness
  • Anxiety
  • Overwhelming fatigue, even after a good night’s sleep

The prevalence of fibromyalgia ranges from 0.5% to 5.8% and is more common in women than in men.

The previous recommendations included evidence collected and assessed up to 2005 and expert opinions. The updated recommendations are developed by a multidisciplinary group from 12 countries. The team conducted systematic reviews and meta-analyses on pharmacological and non-pharmacological management of fibromyalgia, including pain, fatigue, sleep, and different aspects of daily living.

The group looked at 275 full papers and 106 reviews. In the pharmacological category, the group looked at amitriptyline, anticonvulsants, growth hormone, monoamine oxidase inhibitors (MAOIs), non-steroidal anti-inflammatory drugs (NSAIDs), serotonin-noradrenaline reuptake inhibitors, selective serotonin reuptake inhibitors, sodium oxybate, and tramadol. The non-pharmacologic treatments reviewed included but not limited to acupuncture, capsaicin, exercise, massage, and mindfulness/mind-body therapy.

The new recommendations include:

  • Exercise was the only “strong for” therapy-based recommendation.
  • There should be a graduated approach involving four main stages and involves shared decision-making with patients.
  • Initial treatment should include patient education and non-pharmacological treatments.
  • If initial treatment is non-responsive, additional therapies, on a case to case basis, can include psychological therapies for mood disorders, taking medications for severe pain or sleep disturbance and rehabilitation program for severe disability.

Study authors noted that prioritized research is needed to determine who will benefit from which interventions and “their effect in combination and organization of healthcare systems to optimize outcome.” The committee recommended a review in 5 years. The review will see whether treatments with relatively small current evidence now would be studied in more detail and if new treatments have been developed.