Ernest Choy – Rheumatology, Institute of Infection and Immunity, Cardiff University School of Medicine.
The Challenge
Fibromyalgia is a condition that causes chronic health problems with pain, tenderness and muscle stiffness throughout the body, with around 2% of the general population currently suffering from the condition.
Although pain is the dominant symptom in fibromyalgia, other symptoms such as fatigue, problems sleeping, mood disturbance and cognitive impairment (problems with a person’s thinking, communication, understanding or memory) are common and can have an important influence on the quality of life – with the condition’s diagnosis and management remains a challenge for patients and healthcare professionals.
The European League Against Rheumatism (EULAR) recommendations for the management of fibromyalgia assessed evidence up to 2005. Given the lack of information and poor quality of the studies available, it was recommended that the guidelines be revised after a period of 4 years. However, no subsequent revision took place and a decade later an international working group were tasked with revisiting the recommendations with the aim of making them more evidence-based.
The Research
The working group was made up of 18 members from across 12 European countries including clinicians, non-clinical scientists, patient representatives and the allied health professions (nursing). The group, which included a Clinical Professor from NCPHWR, assessed evidence with an aim to make recommendations for the use of individual pharmacological treatments (interventions using medications) and non-pharmacological approaches (interventions that do not involve medications), and how these can be combined. The team also aimed to identify priority areas for future research.
The Findings
- Optimal management requires prompt diagnosis.
- There should be a comprehensive assessment of pain, function and the psychosocial context.
- Management should take the form of a graduated approach with the aim of improving health-related quality of life.
- Initial management should involve patient education and focus on non-pharmacological therapies.
- Of the non-pharmacological therapies studied, the group strongly recommended the use of exercise, particularly given its effect on pain, physical function and well-being, availability, relatively low cost and lack of safety concerns.
- A graduated approach to exercise was suggested which should be underpinned by shared decision-making with patients.
- In case of non-response, further therapies should be tailored to the specific needs of the individual and may involve:
- Psychological therapies – for mood disorders. Cognitive Behavioural Therapy (a talking therapy that helps teach coping skills) was effective at producing modest to long-term reductions in pain, disability and improving mood.
- Pharmacotherapy (using certain medications which the study found to be more efficient) – were recommended for severe pain or sleep disturbance.
- Multi-activity rehabilitation programmes were advised for severe disability.
The Impact
These recommendations incorporate a decade of evidence in relation to the pharmacological and non-pharmacological management of fibromyalgia. The findings have greatly improved our understanding – with the recommendations from the study being shared internationally through national rheumatology societies, meetings, and education programmes.
Importantly, the study identified priority areas for future research. These areas focus on matching patients to the best therapies and treatments, and the better organisation of healthcare systems to optimise outcomes. It is hoped that this can help pave the way for new research that can be used to help target treatments more effectively, leading to significantly better quality of life for patients and reduced cost to healthcare providers.
For further information on the research, recommendations and future priorities, visit: https://ard.bmj.com/content/76/2/318
