ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 0024

An International Delphi Consensus on Non-pharmacological Interventions for Fibromyalgia

Burak Kundakci1, Michelle Hall1, Fabiola Atzeni2, Jaime C. Branco3, Dan Buskila4, Daniel Clauw5, Leslie J. Crofford6, Mary-Ann Fitzcharles7, Vasileios Georgopoulos8, Robert D. Gerwin9, Eva Kosek10, Gary Macfarlane11, Caroline Neal12, Nathan J. Rudin13, Sarah Ryan14, José A. P. da Silva15, Ann Taylor16, Dennis C. Turk17, Daniel Whibley18, Michael Doherty19, Weiya Zhang20 and Abhishek Abhishek1, 1University of Nottingham, Nottingham, United Kingdom, 2Rheumatology Unit, University of Messina, Messina, Italy, 33.CEDOC, NOVA Medical School, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal; 7.Hospital Egas Moniz (CHLO) (Rheumatology Department), Lisboa, Portugal, Lisboa, Portugal, 4Ben Gurion University of the Negev, Beer – Sheva, Israel, Beer-Sheva, Israel, 5Michigan Medicine, Ann Arbor, MI, 6Vanderbilt University Medical Center, Nashville, TN, 7McGill University, montreal, Canada, 8University of Nottingham, Nottingham, 9Johns Hopkins University, Baltimore, 10Karolinska Institutet, Stockholm, Sweden, 11University of Aberdeen, Aberdeen, Scotland, United Kingdom, 12Primary Integrated Community Services Ltd, Nottingham, United Kingdom, 13University of Wisconsin, Madison, 14Midlands NHS Foundation Trust and Keele University, Stoke on trent, United Kingdom, 159.Centro Hospitalar e Universitário Coimbra (Rheumatology Department), Coimbra, Portugal, Coimbra, Portugal, 16Cardiff University School of Medicine, Cardiff, United Kingdom, 17University of Washington School of Medicine, Seattle, WA, 18University of Aberdeen, Ann Arbor, MI, 19Academic Rheumatology, School of Medicine, University of Nottingham, UK, Nottingham, England, United Kingdom, 20Academic Rheumatology, School of Medicine, University of Nottingham, UK, Nottingham, United Kingdom

Meeting: ACR Convergence 2020

Keywords: ,

Session Information

Date: Friday, November 6, 2020

Title: Fibromyalgia & Other Clinical Pain Syndromes Poster

Session Type: Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Fibromyalgia (FM) impacts directly on health and quality of life (QoL) of patients and associates with a large health economic burden. Non-pharmacological interventions are recommended as first-line treatment for FM1. However, there are no evidence-based recommendation for which intervention(s) to offer to patients with different manifestations of FM as core and adjunctive treatments. The aim of this Delphi exercise was to prioritise non-pharmacological treatments for FM based on the results of our meta-analysis2.

Methods: A three-stage Delphi exercise was designed. Panel members were selected from the author list of EULAR, American Pain Society and Canadian FM guidelines and local clinicians with expertise in FM. In the first round Delphi survey, participants were asked to select interventions that they thought should be offered to people with FM, and then rate these interventions as either core or adjunctive treatments separately for pain, fatigue, sleep and depression. They were provided a summary of current research evidence from our recent meta-analysis to support their decision-making. Items receiving more than 70% votes were accepted, those receiving less than 30% were rejected and those obtaining between 30-70% were recirculated in the following rounds.

Results: Seventeen of 48 invitees agreed to participate and completed the 3 rounds of the survey. There were 7 rheumatologists, 2 physiotherapists, 1 pain specialist,1 psychologist, 1 nurse and 5 other professionals. This Delphi exercise identified 14 non-pharmacological interventions for pain, 11 for fatigue, 12 for sleep and 11 for depression that were considered potentially accessible and beneficial for the four common manifestations of FM (Table 1). Aerobic exercise, education, sleep hygiene and cognitive behavioural therapy were supported as core treatments for all manifestations. Other interventions, including music, periods of relaxation/enjoyment during the day, use of hot baths and local heat, achieved consensus as adjunctive treatments for certain outcomes (Table 2).

Conclusion: This Delphi exercise provides an up-to-date consensus of expert practitioners and researchers on core and adjunctive non-pharmacological treatments for four manifestations of FM, specifically pain, fatigue, sleep and depression. This information will inform the development of a complex non-pharmacological treatment package for FM which will subsequently be tested in clinical research.

  1. Macfarlane, G.J., et al., EULAR revised recommendations for the management of fibromyalgia. Annals of the rheumatic diseases, 2017. 76(2): p. 318-328.
  2. Kundakci B, Kaur J, Goh S, Hall M, Doherty M, Zhang W, Abhishek A. The Efficacy of Non-Pharmacological Interventions for Fibromyalgia: A Systematic Review with Meta-Analysis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/the-efficacy-of-non-pharmacological-interventions-for-fibromyalgia-a-systematic-review-with-meta-analysis/. Accessed May 27, 2020.

Table 1. Accepted non-pharmacological interventions and percentage of agreement for pain, fatigue, sleep and depression

Table 2. The classification of accepted non-pharmacological interventions as core or adjunctive for pain, fatigue, sleep and depression

Disclosure: B. Kundakci, None; M. Hall, None; F. Atzeni, None; J. Branco, None; D. Buskila, None; D. Clauw, Pfizer, 1, 2, Tonix, 1, Aptinyx, 1, 2, Daiichi Sankyo, 1, Samumed, 1, Intec Pharma, 1, Eli Lilly, 1, Zynerba, 1, Williams & Connolly LLP, 1, Nix Patterson LLP, 1, Theravance, 1; L. Crofford, None; M. Fitzcharles, None; V. Georgopoulos, None; R. Gerwin, None; E. Kosek, None; G. Macfarlane, Amgen, 1, GlaxoSmithKline, 1; C. Neal, None; N. Rudin, None; S. Ryan, None; J. da Silva, MyFibromyalgia®, a webcompany delivering services to patients with Fibromyalgia, 9; A. Taylor, None; D. Turk, None; D. Whibley, None; M. Doherty, None; W. Zhang, None; A. Abhishek, None.

To cite this abstract in AMA style:

Kundakci B, Hall M, Atzeni F, Branco J, Buskila D, Clauw D, Crofford L, Fitzcharles M, Georgopoulos V, Gerwin R, Kosek E, Macfarlane G, Neal C, Rudin N, Ryan S, da Silva J, Taylor A, Turk D, Whibley D, Doherty M, Zhang W, Abhishek A. An International Delphi Consensus on Non-pharmacological Interventions for Fibromyalgia [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/an-international-delphi-consensus-on-non-pharmacological-interventions-for-fibromyalgia/. Accessed .

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