title: EULAR revised recommendations for the management of fibromyalgia.
abstract: OBJECTIVE
  The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'.
  
  
  METHODS
  A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.
  
  
  RESULTS
  2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).
  
  
  CONCLUSIONS
  These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.
authors.affiliation: Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Macfarlane
authors.affiliation: Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.|Department of Rheumatology, Cantonal Hospital, Fribourg, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Kronisch
authors.affiliation: Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
authors.forename: L E
authors.initials: LE
authors.lastname: Dean
authors.affiliation: ICRCCS Galeazzi Orthopaedic Institute, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Atzeni
authors.affiliation: Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany.|Department of Psychosomatic Medicine, Technische Universität München, München, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Häuser
authors.affiliation: Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
authors.forename: E
authors.initials: E
authors.lastname: Fluß
authors.affiliation: Section of Rheumatology, Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: E
authors.initials: E
authors.lastname: Choy
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Spine Centre, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Kosek
authors.affiliation: Department of Rheumatology, Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Amris
authors.affiliation: Rheumatology Department, CEDOC-NOVA Medical School, UNL, CHLO, Hospital Egas Moniz, Lisbon, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Branco
authors.affiliation: Hacettepe University Division of Internal Medicine, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Dincer
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Leino-Arjas
authors.affiliation: Patient Representative, Bristol, UK.
authors.forename: K
authors.initials: K
authors.lastname: Longley
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: G M
authors.initials: GM
authors.lastname: McCarthy
authors.affiliation: Patient Representative, Limassol, Cyprus.
authors.forename: S
authors.initials: S
authors.lastname: Makri
authors.affiliation: Centre de la Douleur, Hôpital Cochin-Hôtel Dieu, Université Paris Descartes, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Perrot
authors.affiliation: Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Sarzi-Puttini
authors.affiliation: Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: A
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
authors.forename: G T
authors.initials: GT
authors.lastname: Jones
mesh_terms: D000203:Activities of Daily Living; D015670:Acupuncture Therapy; D000639:Amitriptyline / Q000031:analogs & derivatives / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D002211:Capsaicin / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D005060:Europe; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005221:Fatigue / Q000503:physiopathology / Q000628:therapy*; D005356:Fibromyalgia / Q000503:physiopathology / Q000628:therapy*; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D006875:Hydrotherapy; D006990:Hypnosis; D026882:Manipulation, Chiropractic; D008405:Massage; D026441:Mind-Body Therapies; D064866:Mindfulness; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D010146:Pain / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D012436:S-Adenosylmethionine / Q000627:therapeutic use; D018689:Sensory System Agents / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000627:therapeutic use; D012890:Sleep; D012955:Societies, Medical; D012978:Sodium Oxybate / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000639:Amitriptyline; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D002211:Capsaicin; D019382:Human Growth Hormone; D008996:Monoamine Oxidase Inhibitors; D012436:S-Adenosylmethionine; D018689:Sensory System Agents; D017367:Selective Serotonin Reuptake Inhibitors; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors; D012978:Sodium Oxybate; C004704:cyclobenzaprine
keywords: Fibromyalgis/Pain Syndromes; Multidisciplinary team-care; Treatment