Revised fibromyalgia guidelines by EULAR for better patient management

The European League Against Rheumatism (EULAR) has revised guidelines regarding fibromyalgia in order to improve the management of patients with this chronic conditions. The guidelines offer evidence-based recommendations, including non-pharmacologic and psychological interventions.

The updated guidelines come after a decade since the original recommendations for fibromyalgia management appeared. The authors wrote, “[These recommendations] allow EULAR to move from recommendations that are predominantly based on expert opinion to ones that are firmly based on scientific evidence from high-quality reviews and meta-analyses.”

The researchers reviewed 107 systemic reviews and meta-analyses. They found the strongest evidence for exercise being a part of initial therapy for fibromyalgia management. Other recommendations suggest an individualized approach to treatment, which may include pharmacologic, psychological, and/or rehabilitative interventions, depending on the individual patient.

Leslie J. Crofford, M.D., director of the Division of Rheumatology & Immunology at Vanderbilt University, added, “These new EULAR guidelines are based on the most up-to-date information and are in line with the thinking of most clinicians working in the area of [fibromyalgia].”

Dr. Cofford explained the new guidelines may be a result of a strong push toward pharmacological intervention for fibromyalgia, as there is lack of knowledge for non-pharmacological interventions. There may also be a bias towards pharmacological interventions, as there is a lack of access to non-pharmacological interventions in the U.S.

Along with recommendations, the working group articulated five key questions that are meant to guide further research into fibromyalgia management:

• Is monotherapy better than a multimodal approach?
• What type of exercise is most beneficial (strength or aerobic training)?
• Do patient characteristics predict therapeutic response?
• Does fibromyalgia with concurrent inflammatory joint disease require a different therapeutic approach?
• Who is best equipped to manage patients with fibromyalgia?

The group believes keeping these questions in mind will help improve the management of fibromyalgia patients.

Fibromyalgia treatment

Fibromyalgia may be addressed with pharmacological and non-pharmacological methods. Still, because the cause of fibromyalgia is unknown, treating the condition is a challenge. Therefore, the goal of fibromyalgia treatment is symptom management. A doctor may prescribe analgesics, or painkillers, to help with the condition. However, there is a risk of developing addiction to these drugs, so doctors may recommend this option with caution. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be taken for pain management, but once again long-term use of these drugs can yield unwanted side effects. In some cases, antidepressants may be prescribed as well.

Some alternative and complementary therapies and treatments for fibromyalgia include massages, acupuncture, cognitive behavioral therapy, movement therapies, and chiropractic. As a patient with fibromyalgia, you may find combining pharmacological and complementary treatment methods offers you the best success in managing your condition.