Recommendations
| Recommendation | Level of evidence | Grade | Strength of recommendation | Agreement (%)* |
|---|---|---|---|---|
| Overarching principles | ||||
| Optimal management requires prompt diagnosis. Full understanding of fibromyalgia requires comprehensive assessment of pain, function and psychosocial context. It should be recognised as a complex and heterogeneous condition where there is abnormal pain processing and other secondary features. In general, the management of FM should take the form of a graduated approach. | IV | D | 100 | |
| Management of fibromyalgia should aim at improving health-related quality of life balancing benefit and risk of treatment that often 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, sleep disturbance and patient preferences and comorbidities; by shared decision-making with the patient. Initial management should focus on non-pharmacological therapies. | IV | D | 100 | |
| Specific recommendations | ||||
| Non-pharmacological management | ||||
| Aerobic and strengthening exercise | Ia | A | Strong for | 100 |
| Cognitive behavioural therapies | Ia | A | Weak for | 100 |
| Multicomponent therapies | Ia | A | Weak for | 93 |
| Defined physical therapies: acupuncture or hydrotherapy | Ia | A | Weak for | 93 |
| Meditative movement therapies (qigong, yoga, tai chi) and mindfulness-based stress reduction | Ia | A | Weak for | 71–73 |
| Pharmacological management | ||||
| Amitriptyline (at low dose) | Ia | A | Weak for | 100 |
| Duloxetine or milnacipran | Ia | A | Weak for | 100 |
| Tramadol | Ib | A | Weak for | 100 |
| Pregabalin | Ia | A | Weak for | 94 |
| Cyclobenzaprine | Ia | A | Weak for | 75 |
*Percentage of working group scoring at least 7 on 0–10 numerical rating scale assessing agreement.