Tuesday, 17 Sep 2019

You are here

EULAR Revised Recommendations for Fibromyalgia

The European League Against Rheumatism (EULAR) recommendations for fibromyalgia (FM) management were published in 2007 and largely had recommendations based on expert opinion’.  These guidelines were updated in May of 2015 after a systematic reviews and meta-analyses of the data.

The following recommendations are based on 275 full papers and 107 literature reviews.

Compared to the 2007 recommendations, there are no major changes to the approach of managing FM. There are more trials and some new new evidence to support some non-pharmacological therapies. Lastly, these recommendations are now evidence based.

Overarching principles:

  • Optimal management requires prompt diagnosis. Full understanding of fibromyalgia requires comprehensive assessment of pain, function and psychosocial context. It should be recognised as a complex and heterogeneous condition where there is abnormal pain processing and other secondary features.
  • In general, the management of FM should take the form of a graduated approach.
  • Management of fibromyalgia should aim at improving health-related quality of life balancing benefit and risk of treatment that often requires a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities tailored according to pain intensity, function, associated features (such as depression), fatigue, sleep disturbance and patient preferences and comorbidities; by shared decision-making with the patient.
  • Initial management should focus on non-pharmacological therapies. 

Specific recommendations:

Non-pharmacological management (most of these have weak evidence)

  • Aerobic and strengthening exercise
  • Cognitive behavioral therapies  
  • Multicomponent therapies
  • Defined physical therapies: acupuncture or hydrotherapy
  • Meditative movement therapies (qigong, yoga, tai chi) and mindfulness-based stress reduction

Pharmacological management  (the size of effect for most treatments is relatively modest)

  • Amitriptyline (at low dose)
  • Duloxetine or milnacipran 
  • Tramadol 
  • Pregabalin
  • Cyclobenzaprine 

Proposed research needs.  The panel identified the following questions that merit further research:

  • Which type of exercise is most effective: strength and/or aerobic training?
  • Are combined pharmacological and non-pharmacological approaches to management more effective than single-modality management?
  • Are there characteristics of patients with fibromyalgia that predict response to specific therapies?
  • How should fibromyalgia be managed when it occurs as a comorbidity to inflammatory arthritis?
  • What aspects of a healthcare system optimise outcome for patients (who is best for the management of FM patients)?

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

A Potential Biomarker for Chronic Fatigue Syndrome Patients

Myalgic encephalomyelitis/chronic fatigue syndrome affects at least 2 million people in the United States and bears tremendous overlap with fibromyalgia - both being difficult to diagnosis because the symptom complex is often unrecognized and these conditions have no biomarker test. 

NIH Conference Review of Chronic Fatigue Syndrome

The current issue of JAMA reviews recent advances on chronic fatigue syndrome, also known as myalgic encephalomyelitis/(ME/CFS), based on a 2-day conference held at the NIH in an April 2019. The NIH 2-day conference reviewed recent progress and new research in several areas described below.

Study Looks at Opioid Use After Knee Surgery

A small study looked at whether reducing the number of opioid tablets prescribed after knee surgery would reduce postoperative use and if preoperative opioid-use education would reduce it even more.

Gabapentinoid Drugs Overuse and Misuse

A recent article in JAMA by Drs. Goodman and Brett reviews the increasing off label use of gabapentinoid drugs, originally developed as antiseizure drugs that are now increasingly prescribed for painful conditions.

Pilot Study Targets Insulin Resistence in Fibromyalgia

An unusual pilot study has shown that insulin resistence (IR), assessed by Hgb-A1c levels, was more prevalent in fibromyalgia (FM) patients compared to non-diabetic controls and that when FM patients were given metformin, half had complete resolution of their pain.