EULAR revised recommendations for the management of fibromyalgia

Area of Science:

• Rheumatology and Pain Management
• Evidence-Based Medicine
• Clinical Practice Guidelines

Background:

• Previous European League Against Rheumatism (EULAR) fibromyalgia management recommendations (pre-2005) were largely based on expert opinion due to limited evidence.
• A significant gap existed in high-quality evidence for fibromyalgia treatments, necessitating updated guidelines.

Purpose of the Study:

• To develop updated, evidence-based clinical practice guidelines for managing fibromyalgia.
• To systematically review and assess the evidence for both pharmacological and non-pharmacological fibromyalgia treatments.

Main Methods:

• A multidisciplinary international group conducted a systematic review of publications up to May 2015, focusing on meta-analyses.
• Key outcomes assessed included pain, fatigue, sleep quality, and daily functioning.
• The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was employed to formulate recommendations.

Main Results:

• Of 2979 titles reviewed, 107 meta-analyses/reviews were eligible.
• Exercise was the only therapy with a 'strong for' recommendation based on meta-analyses.
• A four-stage graduated approach is suggested, starting with patient education and non-pharmacological therapies, followed by tailored psychological therapies, pharmacotherapy, or multimodal rehabilitation for non-responders, all with 'weak for' evidence.

Conclusions:

• The updated recommendations are supported by high-quality systematic reviews and meta-analyses.
• The effect size for most recommended fibromyalgia treatments is modest.
• Further research is needed to identify patient subgroups who benefit from specific interventions, combination therapies, and optimal healthcare system organization.