Exercise Strongly Recommended to Manage Fibromyalgia
A decade after its last recommendations for management of fibromyalgia, the European League Against Rheumatism (EULAR) has produced updated guidelines based on the body of evidence that has accumulated since the last report, based on scientific evidence from study reviews and meta-analyses rather than predominantly expert opinion, as the 2005 recommendations were.
The 18-member committee found no major changes in the approach to managing fibromyalgia, but new evidence was introduced to support non-pharmacological therapies as first-line therapy.
What is Fibromyalgia? Widespread body pain is the main symptom of fibromyalgia, but other symptoms include fatigue, non-refreshed sleep, mood disturbances, and in some cases, cognitive impairment. The condition affects two to four percent of the population, predominantly women. It often takes more than two years for a diagnosis to be made, with an average of 3.7 consultations with different physicians, the committee reported.
Exercise Trumps Medication. Both aerobic and strengthening exercises were lauded for improving pain and physical function, with neither modality considered superior to the other. Land and aquatic exercise were deemed equally effective. The committee noted that exercise had significant benefits in pain relief, physical function, and general well-being, was readily available at relatively low cost, and had few safety concerns.
Strong vs. Weak. The committee’s recommendations ranged from “Weak” to “Strong” across the range of available therapies, with exercise the clear winner (“Strong”), and the most strongly endorsed treatment for fibromyalgia.
Pharmacological therapies were judged “weak,” though the committee recommended that patients with severe pain should be considered for treatment with a number of modalities, not just a single therapy, and could be considered for treatment with duloxetine, pregabalin, or tramadol, despite weak evidence to support any of these treatments.
Nonsteroidal anti-inflammatory drugs (NSAIDs), monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors were not recommended because of their ineffectiveness. The committee specifically recommended against sodium oxybate, growth hormone, opioids, and corticosteroids for lack of effectiveness and risk of side effects and inappropriate use.
Prompt Diagnosis. Successful management of fibromyalgia requires a prompt diagnosis based on a comprehensive assessment of pain, function, and psychosocial context, and should be recognized as a “complex and heterogeneous condition where there is abnormal pain processing and other secondary features.” Management of fibromyalgia should aim at improving health-related quality of life, balancing benefit and risk of treatment depending on pain intensity, physical function, and secondary characteristics such as depression, fatigue, sleep disturbance and comorbidities, the panel advised, and there should be shared decision-making between patient and health providers. (Annals of the Rheumatic Diseases, July 21, 2016.)
The post Exercise Strongly Recommended to Manage Fibromyalgia appeared first on University Health News.
Read Original Article: Exercise Strongly Recommended to Manage Fibromyalgia »
Powered by WPeMatico
