EULAR evidence based recommendations for the management of fibromyalgia syndrome

S F Carville ^1*, S Arendt-Nielsen ², H Bliddal ³, F Blotman ⁴, J C Branco ⁵, D Buskila ⁶, J AP Da Silva ⁷, B Danneskiold-Samsøe ³, F Dincer ⁸, C Henriksson ⁹, K Henriksson ¹⁰, E Kosek ¹¹, K Longley ¹², G M McCarthy ¹³, S Perrot ¹⁴, M J Puszczewicz ¹⁵, P Sarzi-Puttini ¹⁶, A Silman ¹⁷, M Späth ¹⁸ and E H Choy ¹

¹ King's College London, United Kingdom
² Aalborg University, Denmark
³ The Parker Institute, Frederiksberg Hospital, Denmark
⁴ Hospital Lapyeronie, France
⁵ Hospital Egas Moniz, Portugal
⁶ Soroka Medical Center, Israel
⁷ Hopitais Da Universidade, Portugal
⁸ Hacettepe Medical School, Turkey
⁹ INR, Linkoping University, Sweden
¹⁰ University Hospital Linkoping, Sweden
¹¹ Karolinska Institute, Sweden
¹² Bath, United Kingdom
¹³ Mater Misericordiae University Hospital, Republic of Ireland
¹⁴ Hospital Cochin,, France
¹⁵ Rehabilitation and Internal Medicine University of Medical Sciences, Poland
¹⁶ Sacco University Hospital, Italy
¹⁷ University of Manchester, United Kingdom
¹⁸ University of Munich, Germany

^* To whom correspondence should be addressed. E-mail: serena.carville{at}kcl.ac.uk.

Accepted 5 July 2007

Abstract

Objective: To develop evidence based recommendations for the management of fibromyalgia syndrome (FMS).

Methods: A multidisciplinary task force was formed representing eleven European Countries. The design of the study including search strategy, participants, interventions, outcome measures, data collection and analytical method was defined at the outset. A systematic review was undertaken with the keywords ‘fibromyalgia’, ‘treatment or management’ and ‘trial’. Studies were excluded if they did not utilise the ACR classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale (VAS) and fibromyalgia impact questionnaire (FIQ). The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation.

Results: One hundred and forty six studies were eligible for the review. Thirty nine pharmacologic intervention studies and 59 non-pharmacologic were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and ‘other pharmacological’ and exercise, cognitive behavioural therapy, education, dietary interventions and ‘other non-pharmacological’. In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made.

Conclusion: Nine recommendations for the management of FMS were developed using a systematic review and expert consensus.

Keywords: EULAR, fibromyalgia, management, systematic review

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