EULAR evidence-based recommendations for the management of fibromyalgia syndrome
Open accessAbstract
Objective To develop evidence-based recommendations for the management of fibromyalgia syndrome.Methods A multidisciplinary task force was formed representing 11 European countries. The design of the study, including search strategy, participants, interventions, outcome measures, data collection and analytical method, was defined at the outset. A systematic review was undertaken with the keywords "fibromyalgia", "treatment or management" and "trial". Studies were excluded if they did not utilise the American College of Rheumatology classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale and fibromyalgia impact questionnaire. The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation.Results 146 studies were eligible for the review. 39 pharmacological intervention studies and 59 non-pharmacological were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and "other pharmacological" and exercise, cognitive behavioural therapy, education, dietary interventions and "other non-pharmacological". In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made.Conclusions Nine recommendations for the management of fibromyalgia syndrome were developed using a systematic review and expert consensus.
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Exercise interventions and psychological therapies such as cognitive behavioural therapy are known to be effective for patients with chronic pain.
“Exercise interventions and psychological therapies, such as cognitive behavioural therapy (CBT), are examples of conservative treatments that are known to be effective for patients with chronic pain [5, 6, 9–12].”
From Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain: study protocol for a randomised controlled trial. (2018) · cites this paper as [10]
Table 4 (Discussion; page not available in our copy) says tailored exercise can benefit some patients with fibromyalgia and CBT may benefit some patients. The claim broadens those qualified recommendations to patients with chronic pain generally and describes both treatments as known to be effective, whereas the paper says its CBT recommendation rests on expert opinion and poor-quality trials. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAerobic exercise, hydrotherapy, and multicomponent therapy have shown efficacy in alleviating fibromyalgic symptoms without harms.
“Aerobic exercise, hydrotherapy, and multicomponent therapy have shown efficacy in alleviating fibromyalgic symptoms without harms, and can be offered to the patient either as alternative or used adjunctively with pharmacological therapy.7,8,30,33,41”
From Comparative Efficacy and Harms of Duloxetine, Milnacipran, and Pregabalin in Fibromyalgia Syndrome (2010) · cites this paper as [8]
The Assessment of recommendations (page not available) reports improvements with heated-pool treatment and some aerobic-exercise trials; it also describes multidisciplinary care as often needed, while noting limited high-quality trial evidence. It says adverse-event drop-out was very low for heated-pool treatment and describes exercise as safe, but does not establish that all three therapies are without harms. The recommendations table (Discussion, page not available) supports tailoring a combination of non-pharmacological and pharmacological treatments, though it does not establish that each therapy can be used as an alternative to medication. (LLM, conf=0.88)
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- Authors
- Carville, S. F., Arendt-Nielsen, S., Bliddal, H., Blotman, F., Branco, J. C., Buskila, D., Da Silva, J. A. P., Danneskiold-Samsøe, B., Dincer, F., Henriksson, C., Henriksson, K. G., Kosek, E., Longley, K., McCarthy, G. M., Perrot, S., Puszczewicz, M., Sarzi-Puttini, P., Silman, A., Späth, M., & Choy, E. H.
- Affiliations
- King's College London (GB)
- Frederiksberg Hospital (DK)
- Hôpital Lapeyronie (FR)
- Hospital de Egas Moniz (PT)
- Soroka Medical Center (IL)
- Linköping University (SE)
- Linköping University Hospital (SE)
- Karolinska Institutet (SE)
- Mater Misericordiae University Hospital (IE)
- Hôpital Cochin (FR)
- Poznan University of Medical Sciences (PL)
- University of Manchester (GB)
- Corresponding author
- Carville, S F
- ORCID
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2008-04
- Volume
- 67
- Issue
- 4
- Pages
- 536-541
- ISSN
- 0003-4967 (ISSN-L)
- OpenAlex
- W2144915944
- Semantic Scholar
- 84b828205de2e816a68b107e5e03870f8d211480
- Cited by
- 752
- References
- 66
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 9 · 2023: 17 · 2022: 18 · 2021: 10 · 2020: 21 · 2019: 17 · 2018: 22 · 2017: 28 · 2016: 48 · 2015: 45 · 2014: 52 · 2013: 70 · 2012: 83
- FWCI
- 44.21
- Type
- journal article
- Language
- en
- Update notices
- erratum (2015-02-01)
- Open access
- bronze
- doi.org
- Locations
- Annals of the Rheumatic Diseases (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Hacettepe University Institutional Repository (hacettepe.edu.tr) (submittedVersion, other-oa)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- fibromyalgia, fibromyalgia management, pharmacotherapy, antidepressants, analgesics, non-pharmacological treatment, exercise therapy, cognitive behavioral therapy, patient education, dietary intervention, pain intensity, Fibromyalgia Impact Questionnaire, chronic pain
- MeSH terms
- Analgesics, Opioid, Antidepressive Agents, Balneology, Fibromyalgia, Humans, Research Design, Tramadol, Evidence-Based Medicine
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