Mar 21

Review of Guidelines for the management of Fibromyalgia Syndrome

An article has been e-published ahead of print in the European Journal of Pain discussing a review of evidence based guidelines for the management of Fibromyalgia Syndrome (Fibro).

The review aimed to compare the methodology and the recommendations of evidence-based guidelines for the management of Fibro so that the differences between them can be properly understood. 1

Three evidence-based guidelines for the management of Fibro published by professional organisations were identified: The American Pain Society (APS) (2005) 2, the European League Against Rheumatism (EULAR) (2007) 3, and the AWMF (2008) 4.

According to the review article, the steering committees and panels of APS and AWMF were comprised of multiple disciplines engaged in the management of Fibro and included patients, whereas the task force of EULAR only consisted of physicians, predominantly rheumatologists. However, this is not quite true as at least one member of the EULAR task force - Kathy Longley - was a patient and researcher, not a rheumatologist.

APS and AWMF ascribed the highest level of evidence to systematic reviews and meta-analyses, whereas EULAR credited the highest level of evidence to randomised controlled studies. 1

According to the review, both APS and AWMF assigned the highest level of recommendation to aerobic exercise, cognitive-behavioral therapy, amitriptyline, and multicomponent treatment, whilst EULAR assigned the highest level of recommendation to a set of pharmacological treatments. Plus, although there was some consistency in the recommendations regarding pharmacological treatments among the three guidelines, the APS and AWMF guidelines assigned higher ratings to CBT and multicomponent treatments. 1 Whilst this is true, it is worth noting that the EULAR guideline does include:

"Optimal treatment of FMS mandates a multidisciplinary approach, which should include a combination of nonpharmacologic and pharmacologic interventions." 3

The EULAR Guidelines also include a number of specific recommendations on nonpharmacologic (non-medication) approaches.

The review authors note that:

"The inconsistencies across guidelines are likely attributable to the criteria used for study inclusion, weighting systems, and composition of the panels."

References:

  1. Häuser W, Thieme K, Turk DC. Guidelines on the management of fibromyalgia syndrome - A systematic review. Eur J Pain. 2009 Mar 3. [Epub ahead of print]
  2. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004 Nov 17;292(19):2388-95.
  3. Carville SF et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008 Apr;67(4):536-41. Epub 2007 Jul 20. Review.
  4. Eich W, Häuser W, Friedel E, Klement A, Herrmann M, Petzke F, Offenbächer M, Schiltenwolf M, Sommer C, Tölle T, Henningsen P. [Definition, classification and diagnosis of fibromyalgia syndrome] [Article in German] Schmerz. 2008 Jun;22(3):255-66.