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EULAR recommendations underplay importance of severe anxiety and depression in fibromyalgia treatment
  1. Cecilia Mercieca,
  2. Andrew A Borg
  1. Department of Rheumatology, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Cecilia Mercieca, Department of Rheumatology, Mater Dei Hospital, Msida, MSD 2090, Malta; cecilia.mercieca{at}

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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 …

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  • Competing interests None declared.

  • Ethics approval University of Malta Ethics Committee.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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