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The European League Against Rheumatism recently published updated recommendations on the management of fibromyalgia (FM), including pharmacological and non-pharmacological measures.1 While non-pharmacological measures are now the first approach, there is no stratification according to severity of anxiety or depression prior to selecting treatment options.
We are concerned that these recommendations seriously underplay the role of the need of expert psychological and psychiatric assessment prior to the selection of treatment strategies. Severe anxiety and/or depression may prevent the ability to comply with non-pharmacological therapy such as exercise or cognitive behavioural therapy, and the interactions with chronic pain and fatigue can become cyclical and self-perpetuating. Additionally it is known in FM that …