Date: Friday, November 6, 2020
Session 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.
- Macfarlane, G.J., et al., EULAR revised recommendations for the management of fibromyalgia. Annals of the rheumatic diseases, 2017. 76(2): p. 318-328.
- 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.
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 May 15, 2021.
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