Evidence-based guidelines for the treatment of fibromyalgia

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Evidence-based guidelines for the treatment of fibromyalgia

Fibromyalgia is one of the most common chronic pain conditions, and it affects an estimated 3-6% of the world population. Thieme K, et al. compared the recommendations and methodologies published in several recent evidenced-based guidelines for the management of fibromyalgia.  These guidelines were published by 1) American Pain Society (APS; 2005), 2) Canadian Pain Society (CPS; 2013; also used in the United Kingdom), 3) Association of the Scientific Medical Societies in Germany (AWMF; 2012) and 4) European League Against Rheumatism (EULAR; 2016).

Each guideline used systematic reviews and meta-analysis as the highest level of evidence. Moreover,  APS, CPS and AWMF included individual randomized clinical trials as well. The highest ranking of recommendation to aerobic exercise, cognitive-behavioral therapy, amitriptyline and multicomponent treatment were assigned by the APS, CPS and AWMF. In contrast, the highest level of recommendation to exercise was assigned by the most recent EULAR guidelines as opposed to the 2008 EULAR guidelines, which proposed pharmacotherapy. The APS, CPS and AWMF guidelines gave the higher ranking to cognitive-behavioral therapy and multicomponent treatments; however, there was some consistency for pharmacological treatment recommendations among these 4 guidelines. The differences across guidelines can be ascribed to the criteria used for the study inclusion, outcome measures used, weighting systems and the composition of the review panels. In future, a guideline consensus is required to harmonize the discrepancies.


The Journal of Pain

Link to the source:


The original title of the article:

Evidenced-Based Guidelines on the Treatment of Fibromyalgia Patients: Are They Consistent and If Not, Why Not? Have Effective Psychological Treatments Been Overlooked?


Kati Thieme et al.

Therapeutic, Amitriptyline, Fibromyalgia, Nerves, Tricyclic Antidepressant, Guideline
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