A group of experts have provided a list of treatment guidelines for fibromyalgia after reviewing the research.
The European League Against Rheumatism (EULAR) is an organization representing patients, healthcare professionals, and scientific bodies concerned with rheumatic conditions throughout Europe. Their stated aim is to "stimulate, promote, and support the research, prevention, treatment and rehabilitation of rheumatic diseases."
A panel of experts organized by EULAR undertook the task of reviewing the available research on the treatment and management of fibromyalgia and drew up a list of 9 recommendations. The groups recommendations have now been published in the Annals of the Rheumatic Diseases.
The group which consisted of experts from 11 European countries in various fields looked specifically at clinical trials into the treatment of fibromyalgia. Those studies that included patients with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) were excluded. The main measure of the effectiveness of a particular treatment was determined by the change in pain measured by the visual analog scale (VAS), and the fibromyalgia impact questionnaire (FIQ).
From an initial list of 146 clinical studies the EULAR group eventually used 39 pharmacologic intervention studies and 59 nonpharmacologic studies to draw up their recommendations after excluding studies of poor quality or with insufficient data.
The non-drug treatments recommended include a combination of physical and psychological interventions. The physical treatments include heated pool treatment (with or without exercise) and for some fibromyalgia patients, individually tailored exercise programs which may include aerobic exercise and stength training. Physiotherapy and rehabilitation techniques are also suggested in some cases. To help patients cope with their illness mentally and emotionally the group recommends cognitive behavioural therapy and relaxation techniques along with methods of providing psychosocial support.
The drug treatments that the group recommend include specific pain medications such as Tramadol, Tropisetron, pramipexole, and pregabalin. They state that steroids and strong opioids are not appropriate. Certain antidepressants are recommended for the treatment of fibromyalgia as they can decrease pain and often improve the patients overall level of functioning. Specific antidepressant drugs recommended include amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide, and pirlindole.
The advice includes the acknowledgment that ffibromyalgia is a complex and heterogeneous condition and that doctors must make a comprehensive evaluation of the patient's pain, function, and "psychosocial context". It is also emphasized that treatment needs to be tailored to the individuals needs and that there is no single approach that will work for every fibromyalgia patient. A combination of drug and non-drug therapies are recommended.
The EULAR guidelines are the first to be commissioned for fibromyalgia and as such may serve as a great help to physicians who remain confused and often don't know what to do with patients. Eular plans to update the guidelines every 5 years and include new findings from good quality clinical trials.
Whilst efforts to provide coherent treatment guidelines for fibromyalgia based on the best clinical trials available should be commended, it is worth noting that the EULAR guidelines are based on a very narrow point of view and do not include research into complementary and alternative therapies which may benefit fibromyalgia patients. This is evidenced by the fact that the EULAR group disclosed financial relationships with various pharmaceutical companies including Procter and Gamble, Sanofi-Aventis, Roche, Bristol Meyers Squibb, Pierre Fabre, Servier, Pfizer, Eli Lilly, Jazz Pharmaceutical, Allergan, and Wyeth.
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