Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies

Abstract

Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS). First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM) treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin) and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran) were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques).

Acupuncture for Fibromyalgia in Primary Care: A Randomised Controlled Trial

“…15 Ninety-one per cent of patients with fibromyalgia have tried some form of complementary and alternative medicine. 16 Although some treatment guidelines recommend prioritising non-pharmacological interventions, 17 and recent systematic reviews suggest that both cognitive behavioural therapy 18 and approaches such as massage, hydrotherapy and acupuncture may be beneficial in the treatment of fibromyalgia, 19 evidence of benefit is limited.…”

Acupuncture for fibromyalgia in primary care: a randomised controlled trial

“…15 Ninety-one per cent of patients with fibromyalgia have tried some form of complementary and alternative medicine. 16 Although some treatment guidelines recommend prioritising non-pharmacological interventions, 17 and recent systematic reviews suggest that both cognitive behavioural therapy 18 and approaches such as massage, hydrotherapy and acupuncture may be beneficial in the treatment of fibromyalgia, 19 evidence of benefit is limited. 15 One in five patients with fibromyalgia resorts to acupuncture within 2 years of diagnosis.…”

Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration

“…Generally, evidence-based practice guidelines recommend patient-tailored approaches that may include several nonpharmacologic and pharmacologic strategies to reduce symptoms and improve functionality [6][7][8][9]. Briefly, nonpharmacologic strategies include patient education, graded exercise, cognitive behavioral therapy, and complementary and alternative medicine therapies.…”

“…Pharmacologic strategies include treatment with serotonin norepinephrine reuptake inhibitors, treatment with other nonopioid pain-related medications, and limited treatment with opioids. Guidelines also recommend interdisciplinary and integrative team-based approaches that include regular primary care visits and possible comanagement with mental health and rheumatology specialists [6][7][8][9][10][11]. Whether interdisciplinary, team-based combined care approaches are associated with best practices, e.g., less opioid use and more use of nonopioid pain-related medication, is unknown.…”