Fibromyalgia - Which therapeutic approach?
DOI:
https://doi.org/10.32385/rpmgf.v26i1.10709Keywords:
Fibromyalgia, Chronic pain, Guidelines, American Pain Society, European League against RheumatismAbstract
Objectives: To identify the most recommended non-pharmacological and pharmacological treatments for fi bromyalgia based on the level of scientific evidence. Data Source and Review Methods: Literature review in Medline, through PubMed and Medscape, specialized textbook and support literature from congresses consult; between 2005 and 2008. Results: Based on inclusion criteria, selection was made of two guidelines, two systematic review articles and three evidence based review articles. The growing number of studies originates new scientific evidence concerning the therapeutic approach of this disease. The American Pain Society guidelines (2005) highlight diagnostic confirmation, patient education and comorbidities evaluation and treatment. The European League against Rheumatism guidelines (2007) also considers the importance of all comorbidities and symptoms characteristics and intensity when deciding the initial treatment. The Americans defend, as first line the rapy, tricyclic antidepressants and cyclobenzaprine. However, more recent studies confirm the higher efficacy of selective serotonin and norepinephrine reup take inhibitors as well as the alfa2deltaligands-pregabalin, the latter being preferred when the clinicalpicture is dominated by sleep disturbances and anxiety. The absence of a clinical response to monotherapy should bring to consideration the association of these two approaches. Both guidelines consider analgesics and anti-inflammatory drugs as a second line pharmacological treatment. Concerning non-pharmacological treatment, both guidelines recommend physical exercise and cognitive-behavioural the rapy. The combination of pharmacological and non-pharmacological treatment as a part of a multidisciplinary approach should always be the first option, having in mind each individual case. Conclusion: Fibromyalgia implies a high cost in health resources. Therefore it should be approached considering the individual as a bio-psycho-social unit, and be faced as a reality, regarding recent studies. More investigation should be made to better understand the physiopathology of this disease. Only a better comprehension of fibromyalgia will allow the development of newer and more adapted therapeutic options.Downloads
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