Exercise Emerges as Most Effective for Fibromyalgia


The European League Against Rheumatism (EULAR) has updated its recommendations for managing fibromyalgia.

The European League Against Rheumatism (EULAR) has updated its recommendations for managing fibromyalgia. The 2007 recommendations were based on evidence published through 2005.

Diagnosing fibromyalgia can be challenging. It can be years before a diagnosis is made and the average patient meets with 3.7 physicians before they are diagnosed, the authors wrote. Pain is the primary symptom, but other symptoms include fatigue, poor sleep, mood disturbance and cognitive impairment.

Published in the July 4 issue of ARD Online First, the new guidelines were prepared by a multidisciplinary group of clinicians, scientists, patients and nurses from 12 countries. They are based on the results of 107 systematic reviews and meta-analyses that focused on the pharmacological and non-pharmacological management for fibromyalgia.

The updated guidelines differ from the 2007 version in that they are based on scientific evidence. While the previous version marked an important milestone in managing fibromyalgia, it was largely based on expert opinion. But since then, there has been a considerable amount of science published on fibromyalgia.

Still, the authors found no major changes to the approach of managing patients with fibromyalgia. The most notable change in the recommendations was the support of additional non-pharmacological therapies.

“All the recommendations are now firmly evidence based. We now recommend that non-pharmacological therapy should be first-line therapy and then, if there is a lack of effect, there should be individualized therapy according to patient need, which may include pharmacological therapy,” the authors wrote.

The review includes evaluations of pharmacological treatments such as amitriptyline, anticonvulsants (pregabalin and gabapentin), cyclobenzaprine, growth hormone, monoamine oxidase inhibitors, NSAIDs, Serotonin-noradrenalin reuptake inhibitors, selective serotonin reuptake inhibitors and sodium oxybate.

It also includes the evaluation of complementary and alternative medicines and therapies, such as acupuncture, biofeedback, capsaicin, chiropractic, cognitive behavioral therapies, exercise, hydrotherapy/spa therapy, hypnotherapy, massage, meditative movement, mindfulness/mind–body therapy, multicomponent therapy, S-Adenosyl methionine and other complementary and alternative therapies. [[{"type":"media","view_mode":"media_crop","fid":"49897","attributes":{"alt":"©SydaProductions/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_8089180189734","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6066","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©SydaProductions/Shutterstock.com","typeof":"foaf:Image"}}]]

Recommendations fell on a four-point scale:  strongly in favor of treatment, weak in favor of treatment, weak against treatment or strongly against treatment.

Only exercise emerged with a recommendation of strongly in favor of treatment.

“We were unanimous in providing a ‘strong for’ recommendation for the use of exercise, particularly given its effect on pain, physical function and well-being, availability, relatively low cost and lack of safety concerns. The available evidence did not allow us to distinguish between the benefits of aerobic or strengthening,” the authors wrote.

A few therapies emerged with “strongly against” recommendations:  growth hormone evaluation, sodium oxybate, a chiropractic evaluation, guided imagery, homeopathy and opioid use, due to lack of sufficient evidence and safety concerns.




GJ Macfarlane, C Kronisch, et. al.

"EULAR revised recommendations for the management of fibromyalgia."

Ann Rheum Dis doi:10.1136/annrheumdis-2016-209724   

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