Background/Purpose: Although the ideal treatment for fibromyalgia (FM) remains elusive, the medical community requires direction in the care of these patients.  The literature however abounds with copious reports of various treatments that drive health-care costs, but provide ever increasing confusion for patients and physicians. We have compared treatment recommendations for FM provided by recent evidence-based guidelines.

Methods: Systematic searches from January 2008 to February 2013 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, Guidelines International Network and Medline for evidence-based interdisciplinary guidelines on the management of FM were conducted. Inclusion criteria required that the guideline was commissioned by a scientific organisation, the guideline group was interdisciplinary, the systematic search strategy was outlined, criteria and process for classification of evidence and recommendations were stated.

Results: Three evidence-based interdisciplinary guidelines for the treatment of FM in Canada, Germany and Israel fulfilled inclusion criteria.  All three guidelines emphasized a patient-tailored approach according to key symptoms. Non-pharmacologic strategies were the major positive first choice recommendation for all with emphasis on aerobic exercise, cognitive behavioural therapy and multicomponent therapy (exercise and psychological). Acupuncture, hypnosis/guided imagery and Tai Chi were recommended by the German and Israeli guideline, whereas the Canadian guidelines indicated only short term benefits for acupuncture, and categorized   hypnosis/guided imagery and Tai Chi as psychological and exercise interventions respectively with some evidence for effect, but none were specifically recommended. Pharmacologic treatments were less enthusiastically recommended by all three groups. With the qualifier that drugs provide only modest effect, the Canadian and Israeli guidelines gave strong recommendation for the anticonvulsants (gabapentin and pregabalin) and serotonin noradrenaline reuptake inhibitors, whereas these drug categories received only weak recommendation by the German guideline. All groups cautioned about the side effects of drugs manifesting as symptoms of FM.  Use of strong opioids was discouraged by all, with the Israeli and German guideline providing specific negative recommendation for many other drug categories including non-steroidal agents, systemic steroids, benzodiazepines, thyroid hormone replacement, amongst others. Although not providing specific negative treatment recommendations, the Canadian guidelines cited lack of evidence to support many treatments which would therefore constitute “off-label” use.

Conclusion: Recent evidence-based interdisciplinary guidelines concur on the importance of treatments tailored to the individual patient and further emphasize the necessity of self-management strategies which include exercise and psychological techniques.  Contrary to popular perception, drug treatments were recommended with reservation regarding both efficacy and side effect profile.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-paradigm-change-for-treatment-strategies-for-fibromyalgia-syndrome-reflected-by-recommendations-of-recent-evidence-based-interdisciplinary-guidelines-developed-independently-in-three-countries/