General |
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Full understanding of fibromyalgia requires comprehensive assessment of pain, function and psychosocial context. Fibromyalgia should be recognised as a complex and heterogeneous condition where there is abnormal pain processing and other secondary features | IV | D |
Optimal treatment requires a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities tailored according to pain intensity, function, associated features such as depression, fatigue and sleep disturbance in discussion with the patient | IV | D |
Non-pharmacological management |
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Heated pool treatment with or without exercise is effective in fibromyalgia | IIa | B |
Individually tailored exercise programmes, including aerobic exercise and strength training can be beneficial to some patients with fibromyalgia | IIb | C |
Cognitive behavioural therapy may be of benefit to some patients with fibromyalgia | IV | D |
Other therapies such as relaxation, rehabilitation, physiotherapy and psychological support may be used depending on the needs of the individual patient | IIb | C |
Pharmacological management |
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Tramadol is recommended for the management of pain in fibromyalgia | Ib | A |
Simple analgesics such as paracetamol and other weak opioids can also be considered in the treatment of fibromyalgia. Corticosteroids and strong opioids are not recommended | IV | D |
Antidepressants: amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide and pirlindole, reduce pain and often improve function, therefore they are recommended for the treatment of fibromyalgia | Ib | A |
Tropisetron, pramipexole and pregabalin reduce pain and are recommended for the treatment of fibromyalgia | Ib | A |