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International, multidisciplinary Delphi consensus recommendations on non-pharmacological interventions for fibromyalgia

Kundakci, Burak, Hall, Michelle, Atzeni, Fabiola, Branco, Jaime C., Buskila, Dan, Clauw, Daniel, Crofford, Leslie J., Fitzcharles, Mary-Ann, Georgopoulos, Vasileios, Gerwin, Robert D., Kosek, Eva, Macfarlane, Gary J., Neal, Caroline, Rudin, Nathan J., Ryan, Sarah, da Silva, José AP, Taylor, Ann, Turk, Dennis C., Whibley, Daniel, Doherty, Michael, Zhang, Weiya and Abhishek, Abhishek 2022. International, multidisciplinary Delphi consensus recommendations on non-pharmacological interventions for fibromyalgia. Seminars in Arthritis and Rheumatism 57 , 152101. 10.1016/j.semarthrit.2022.152101

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Objectives To develop evidence-based expert recommendations for non-pharmacological treatments for pain, fatigue, sleep problems, and depression in fibromyalgia. Methods An international, multidisciplinary Delphi exercise was conducted. Authors of EULAR and the Canadian Fibromyalgia Guidelines Group, members of the American Pain Society and clinicians with expertise in fibromyalgia were invited. Participants were asked to select non-pharmacological interventions that could be offered for specific fibromyalgia symptoms and to classify them as either core or adjunctive treatments. An evidence summary was provided to aid the decision making. Items receiving >70% votes were accepted, those receiving <30% votes were rejected and those obtaining 30-70% votes were recirculated for up to two additional rounds. Results Seventeen experts participated (Europe (n=10), North America (n=6), and Israel (n=1)) in the Delphi exercise and completed all three rounds. Aerobic exercise, education, sleep hygiene and cognitive behavioural therapy were recommended as core treatments for all symptoms. Mind-body exercises were recommended as core interventions for pain, fatigue and sleep problems. Mindfulness was voted core treatment for depression, and adjunctive treatment for other symptoms. Other interventions, namely music, relaxation, hot bath, and local heat were voted as adjunctive treatments, varying between symptoms. Conclusions This study provided evidence-based expert consensus recommendations on non-pharmacological treatments for fibromyalgia that may be used to individualise treatments in clinical practice targeting the diverse symptoms associated with fibromyalgia.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: License information from Publisher: LICENSE 1: URL:, Start Date: 2022-09-23
Publisher: Elsevier
ISSN: 0049-0172
Date of First Compliant Deposit: 27 September 2022
Last Modified: 19 Oct 2022 13:18

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