Background The two evidence-based European guidelines available gave some divergent recommendations on first line therapies of fibromyalgia syndrome (FMS). Both guidelines did not consider risks and feasibility of therapies (1,2).
Objectives To update the German interdisciplinary evidence-based guideline on FMS (2) by accounting not only for efficacy but also for risks and feasibility of therapies.
Methods The update was performed by 10 German medical and psychological associations and two patient self-help organisations. The task was coordinated by two German scientific umbrella organisations. A systematic search of the literature including all studies of pharmacological and non-pharmacological treatments of FMS was performed in the Cochrane Library Medline, PsychInfo and Scopus, all from inception to December 2010. Predefined criteria were defined for downgrading the level of evidence (classification system of the Oxford-Centre for Evidence Based Medicine) in case of low quantity, methodological quality and external validity of studies. Efficacy was assessed by pooled standardized mean differences of experimental therapy versus controls at the end of treatment, and if available – at follow up - of the outcomes pain, sleep, fatigue and quality of life. Risks were assessed by the frequency and severity of adverse events reported, acceptability by the relative risk ratio of drop outs due any reason in experimental and control groups and feasibility by approval status for the treatment of FMS or comorbid mental disorders in Germany. Grading of the strengths of recommendations was done according to the German program for disease management guidelines by a balance sheet accounting for efficacy, safety, acceptability and feasibility. Standardized procedures were used to reach a consensus on recommendations. The guideline was reviewed and finally approved by the boards of the societies involved. A short version of the guideline for patients was also developed.
Results The following procedures were strongly recommended: aerobic exercise, strength training, multicomponent treatment (cognitive behavioural therapies or relaxation training combined with aerobic exercise) and meditative movement therapies (Ta-Chi, Qi-Gong, Yoga). The choice of treatment options should be based on informed decision-making and respect of the patients’ preferences and comorbidities.
A strong recommendation not to use the following therapies was given: Drugs: cannabinoids, dopamine agonists, ketamin, local anasthetics, milnacipran, muscle relaxants, neuroleptics, non-steroidal agents, serotonine receptor agonists, sodium oxybate, strong opioids, tranquilizer; Complementary therapies: Mindfulness-based stress reduction, nutritional supplements, reiki.
Conclusions Non-pharmacological therapies are first line treatment options for the management of FMS as recommended by the German guideline.
 Carville SF et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 2008;67(4):536-41.
 Häuser W et al. Fibromyalgia syndrome: classification, diagnosis, and treatment. Dtsch Arztebl Int 2009;106(23):383-91.
Disclosure of Interest None Declared