The EULAR guidelines for the management of Fibromyalgia Syndrome (Fibro), which were e-published last July, have now been published in the Annals of the Rheumatic Diseases.

The full article can be seen here, but the evidence-based recommendations are summarised into 9 simple points:

General

  • Full understanding of fibromyalgia requires comprehensive assessment of pain, function, and psychosocial context. Fibromyalgia should be recognised as a complex and heterogeneous condition where there is abnormal pain processing and other secondary features.
  • Optimal treatment 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 and sleep disturbance in discussion with the patient.

Non-pharmacological management

  • Heated pool treatment with or without exercise is effective in fibromyalgia.
  • Individually tailored exercise programmes including aerobic exercise and strength training can be beneficial to some patients with fibromyalgia.
  • Cognitive behavioural therapy may be of benefit to some patients with fibromyalgia.
  • Other therapies such as relaxation, rehabilitation, physiotherapy and psychological support may be used depending on the needs of the individual patient.

Pharmacological management

  • Tramadol is recommended for the management of pain in fibromyalgia. Simple analgesics such as paracetamol and other weak opioids can also be considered in the treatment of fibromyalgia. Corticosteroids and strong opioids are not recommended.
  • Antidepressants: amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide and pirlindole, reduce pain and often improve function, therefore they are recommended for the treatment of fibromyalgia.
  • Tropisetron, pramipexole and pregabalin reduce pain and are recommended for the treatment of fibromyalgia.

Although these are not government accepted guidelines (NICE generally take years to formulate guidelines and the first NICE guidelines on Fibromyalgia, if and when they are published, are likely to be out of date), these are simple, yet comprehensive guidelines and the only such guidelines available. Their brevity makes them attractive to doctors in general as they are quick to get through, but they are still based on a huge amount of evidence.