EULAR revised recommendations for the management of fibromyalgia.

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Abstract

The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'.

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Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes.

L Scascighini, V Toma, S Dober-Spielmann … (2008)

To provide an overview of the effectiveness of multidisciplinary treatments of chronic pain and investigate about their differential effects on outcome in various pain conditions and of different multidisciplinary treatments, settings or durations. In this article, the authors performed a systematic review of all currently available randomized controlled trials (RCTs) fulfilling the inclusion criteria, by using a recently developed rating system aimed to assess the strength of evidence with regard to the methodological quality of the trials. Compared with other non-disciplinary treatments, moderate evidence of higher effectiveness for multidisciplinary interventions was shown. In contrast to no treatment or standard medical treatment, strong evidence was detected in favour of multidisciplinary treatments. The evidence that comprehensive inpatient programmes were more beneficial that outpatient programmes was moderate. Fibromyalgia and chronic back pain patients tended to profit more substantially than patients with diverse origins or chronic pain diagnoses. No evidence was found that treatment variables, such as duration or programme components, were influential for the success of the intervention. A standard of multidisciplinary programmes should be internationally established to guarantee generally good outcomes in the treatment of chronic pain. Our results highlight the lack of quality of design, execution or reporting of many of the RCTs included in this article. Future studies should more specifically focus on differential effects of treatment components and patient variables, allowing the identification of subgroups, which most probably would profit from multidisciplinary pain programmes.

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EULAR evidence-based recommendations for the management of fibromyalgia syndrome.

F Dincer, F Blotman, H Bliddal … (2008)

To develop evidence-based recommendations for the management of fibromyalgia syndrome. 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. 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. Nine recommendations for the management of fibromyalgia syndrome were developed using a systematic review and expert consensus.

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A patient survey of the impact of fibromyalgia and the journey to diagnosis

Ernest Choy, Serge Perrot, Ana Teresa León … (2010)

Background Fibromyalgia is a painful, debilitating illness with a prevalence of 0.5-5.0% that affects women more than men. It has been shown that the diagnosis of fibromyalgia is associated with improved patient satisfaction and reduced healthcare utilization. This survey examined the patient journey to having their condition diagnosed and studied the impact of the condition on their life. Methods A questionnaire survey of 800 patients with fibromyalgia and 1622 physicians in 6 European countries, Mexico and South Korea. Patients were recruited via their physician. Results Over half the patients (61%) were aged 36-59 years, 84% were women, and the mean time since experiencing fibromyalgia symptoms was 6.5 years. Patients had experienced multiple fibromyalgia symptoms (mean of 7.3 out of 14), with pain, fatigue, sleeping problems and concentration difficulties being the most commonly reported. Most patients rated their chronic widespread pain as moderate or severe and fibromyalgia symptoms were on average "fairly" to "very" disruptive, and had a "moderate" to "strong" impact on patients' lives. 22% were unable to work and 25% were not able to work all the time because of their fibromyalgia. Patients waited on average almost a year after experiencing symptoms before presenting to a physician, and it took an average of 2.3 years and presenting to 3.7 different physicians before receiving a diagnosis of fibromyalgia. Patients rated receiving a diagnosis as somewhat difficult on average and had difficulties communicating their symptoms to the physician. Over one third (35%) felt their chronic widespread pain was not well managed by their current treatment. Conclusions This survey provides further evidence that fibromyalgia is characterized by multiple symptoms and has a notable impact on quality of life and function. The diagnosis of fibromyalgia is delayed. Patients wait a significant period of time before presenting to a physician, adding to the prolonged time to diagnosis. Patients typically present with a multitude of symptoms, all resulting in a delay in diagnosis and eventual management. Helping clinicians to diagnose and manage patients with fibromyalgia should benefit both patients and funders of healthcare.

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Author and article information

Journal

Journal ID (iso-abbrev): Ann. Rheum. Dis.

Title: Annals of the rheumatic diseases

Publisher: BMJ

ISSN (Electronic): 1468-2060

ISSN (Print): 0003-4967

Publication date (Electronic): Feb 2017

Volume: 76

Issue: 2

Affiliations

[1 ] Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.

[2 ] Department of Rheumatology, Cantonal Hospital, Fribourg, Switzerland.

[3 ] ICRCCS Galeazzi Orthopaedic Institute, Milan, Italy.

[4 ] Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany.

[5 ] Department of Psychosomatic Medicine, Technische Universität München, München, Germany.

[6 ] Section of Rheumatology, Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.

[7 ] Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Spine Centre, Stockholm, Sweden.

[8 ] Department of Rheumatology, Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark.

[9 ] Rheumatology Department, CEDOC-NOVA Medical School, UNL, CHLO, Hospital Egas Moniz, Lisbon, Portugal.

[10 ] Hacettepe University Division of Internal Medicine, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.

[11 ] Finnish Institute of Occupational Health, Helsinki, Finland.

[12 ] Patient Representative, Bristol, UK.

[13 ] Mater Misericordiae University Hospital, Dublin, Ireland.

[14 ] Patient Representative, Limassol, Cyprus.

[15 ] Centre de la Douleur, Hôpital Cochin-Hôtel Dieu, Université Paris Descartes, Paris, France.

[16 ] Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.

[17 ] Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.

Article

Publisher Item ID: annrheumdis-2016-209724

DOI: 10.1136/annrheumdis-2016-209724

PubMed ID: 27377815

SO-VID: d263e5af-3a20-4615-9447-ac6fd19e4b35

History

Keywords: Fibromyalgis/Pain Syndromes,Multidisciplinary team-care,Treatment

Data availability:

Keywords: Fibromyalgis/Pain Syndromes, Multidisciplinary team-care, Treatment

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EULAR revised recommendations for the management of fibromyalgia.

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Most cited references 70

Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes.

EULAR evidence-based recommendations for the management of fibromyalgia syndrome.

A patient survey of the impact of fibromyalgia and the journey to diagnosis

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Cited by 408

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