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EULAR 9 point plan - Treatment guidelines

As previously reported in FaMily Magazine, The European League Against Rheumatism (EULAR) issued the first guidelines for the treatment of fibromyalgia syndrome (FMS) and published them in the September 17th On-line First issue of the Annals of the Rheumatic Diseases.

While these guidelines are not adopted by NICE (National Institute for Health and Clinical Excellence) as yet, they can be seen as a significant step forward in medical treatment.

Specific recommendations in these guidelines regarding general considerations for management of FMS are as follows

  • Comprehensive evaluation of pain, function, and psychosocial context is needed to understand FMS completely, because it is a complex, heterogeneous condition involving abnormal pain processing and other secondary features.
  • Optimal treatment of FMS mandates a multidisciplinary approach, which should include a combination of non-pharmacologic and pharmacologic interventions. After discussion with the patient, treatment modalities should be specifically tailored based on pain intensity, function, and associated features such as depression, fatigue, and sleep disturbance. 

Specific recommendations on non-pharmacologic management of FMS are as follows:

  • Heated pool treatment, with or without exercise, is effective.
  • For some patients with FMS, individually tailored exercise programs can be helpful. These may include aerobic exercise and strength training.
  • For certain patients with FMS, cognitive behavioral therapy may be beneficial.
  • Based on the specific needs of the patient, relaxation, rehabilitation, physiotherapy, psychological support, and other modalities may be indicated.

Specific recommendations on pharmacologic management are as follows:

  • Tramadol is recommended for management of pain. Although other treatment options may include simple analgesics (eg, paracetamol) and other weak opioids, corticosteroids and strong opioids are not recommended.
  • Antidepressants are recommended for the treatment of FMS because they decrease pain and often improve function. Appropriate options may include amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide, and pirlindole.
  • Tropisetron, pramipexole, and pregabalin are recommended for the treatment of FMS because they reduce pain.

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