If you’ve been diagnosed with mild to moderate fibromyalgia, exercise and other non-drug therapies should be your first line of treatment, according to the European League Against Rheumatism (EULAR), an international group of health professionals in rheumatology. EULAR’s updated fibromyalgia treatment recommendations, published in 2016 in Annals of the Rheumatic Diseases, are similar to the 2007 version, but this time they are based on hard evidence, which was scarce 10 years ago, rather than on expert opinions.
For the updated guidelines, researchers reviewed 107 research papers. Assessing outcomes for pain, fatigue, sleep and daily functioning, they ranked their recommendations of various therapies as “strong for,” “weak for,” “weak against” and “strong against.”
The team also recommended “multicomponent” therapy – rated as “weak for” – which includes educational or psychological therapy and exercise.
Medications are also recommended, but the guidelines advise a “graduated approach,” moving to drug therapies if non-drug options don’t work or if pain is severe and debilitating. Several drugs received “weak for” recommendations (see below), while antidepressants in two classes – selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) – as well as nonsteroidal anti-inflammatory drugs (NSAIDs) received “weak against” recommendations.
Therapies that didn’t fare so well were strong opioids, growth hormones and sodium oxybate (Xyrem); none of these are approved for treating fibromyalgia in the United States.
Having science to back up the recommendations is important, says Leslie J. Crofford, MD, director of the rheumatology and immunology division at Vanderbilt University in Nashville. “There is a cultural tendency in the United States to go to pills first, but the weight of the evidence suggests that non-pharmacological treatments are at least as effective as pharmacological therapies. I think EULAR did a very good job of interpreting the literature and also in recommending against treatments that are not as effective or where the risk-to-benefit ratio is poor.”
How Therapies Rate
Recommendations are strong for: Exercise (aerobic and strength training)
Recommendations are weak for: Acupuncture, cognitive behavioral therapy, spa therapy, meditative movement, mind-body therapy, “multicomponent therapy,” amitriptyline (Elavil), pregabalin (Lyrica), cyclobenzaprine (Amrix, Fexmid, Flexeril, Tabradol FusePaq), duloxetine (Cymbalta), milnacipran (Savella), tramadol (ConZip, Rybix ODT, Ryzolt, Synapryn FusePaq, Ultram)
Recommendations are weak against: SSRI and MAOI antidepressants, NSAIDs, biofeedback, capsaicin, hypnotherapy, massage, SAMe
Recommendations are strong against: Strong opioids, growth hormones, sodium oxybate (Xyrem), chiropractic, corticosteroids
Author: TERRI D’ARRIGO for Arthritis Today
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