Pain

Updated: Fibromyalgia guidelines reflect a decade of evidence


EULAR guidelines for fibromyalgia have been updated for the first time in a decade but their focus does not reflect a novel understanding of the disease or a new approach to management.

Lead author of the guidelines Professor Gary Macfarlane from the University of Aberdeen said the new guidelines differed in the level of evidence to support them.

Since 2007 there had been a plethora of studies and the new guidelines were based on 107 systematic reviews and meta-analysis.

“They allow us to move from recommendations which are based on ‘expert’ opinion to those which are ‘evidence based’” he told the audience.

The guidelines focus on the prompt diagnosis and comprehensive assessment of patients and remain centred on a non-pharmacological approach to management, specifically exercise.

“If there is a lack of effect therapy should be individualised according to patient need, which may include pharmacological therapy” Professor Macfarlane said.

If symptoms are characterised by pain-related depression and anxiety the guidelines recommend cognitive behavioural therapy (CBT).

Professor Macfarlane noted that the size effect for most recommended treatments is relatively modest.

However, many research priorities remained, such as which types of exercise were most effective and was a combined pharmacological and non-pharmacological approach more effective than single modality management.

Australian fibromyalgia expert Professor Geoff Littlejohn said the guidelines indicated there remained a large unmet need for better management of fibromyalgia.

“The basic principles of early diagnosis, clear patient explanation and use of personalised exercise and appropriate psychological strategies remain the cornerstone of management,” he told the limbic.

The guidelines have now been published in full in the Annals of the Rheumatic Diseases. Access the guidelines here.

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