Abstract
Fibromyalgia syndrome (FMS) is a chronic condition with unknown aetiology. The pathophysiology of the disease is incompletely understood; despite advances in our knowledge with regards to abnormal central and peripheral pain processing, and hypothalamo–pituitary–adrenal dysfunction, there is no clear specific pathophysiological therapeutic target. The management of this complex condition has thus perplexed the medical community for many years, and several national and international guidelines have aimed to address this complexity. The most recent guidelines from European League Against Rheumatism (EULAR) (2016), Canadian Pain Society (2012), and The Association of the Scientific Medical Societies in Germany (AWMF) (2012) highlight the change in attitudes regarding the overall approach to FMS, but offer varying advice with regards to the use of pharmacological agents. Amitriptyline, Pregabalin and Duloxetine are used most commonly in FMS and though modestly effective, are useful adjunctive treatment to non-pharmaceutical measures.
Highlights
Fibromyalgia syndrome (FMS) is a chronic condition characterised by generalized body pain, fatigue, sleep disturbance, impaired cognition, and anxiety with unknown aetiology
The Canadian guidelines recommend the use of pharmacological cannabinoids, in the setting of sleep disturbance, it has not received any recommendations by AWMF and European League Against Rheumatism (EULAR)
Discordance between the guidelines on recommendations for pharmacological treatments for of FMS is primarily due to lack of high-quality randomized control trials in FMS, the guidelines rely on lower-quality evidence and expert consensus
Summary
Fibromyalgia syndrome (FMS) is a chronic condition characterised by generalized body pain, fatigue, sleep disturbance, impaired cognition, and anxiety with unknown aetiology. Diagnosis is often made by exclusion of other conditions such as neurological syndromes and depression This lack of a single unifying pathophysiology is mirrored by a complex and non-specific approach to management. Therapeutic classes and targets of pharmacologic therapy in FMS are varied, including classical analgesic therapies such as opiates, and ranging to antidepressants, anticonvulsants, and others This wide range of therapies often leads to confusion in the clinic, and the evidence supporting one therapy over another is limited. This is reflected in the guidance, which offers evidence for the potential utility of each class of pharmacological intervention, but does not necessarily support one form over another and certainly does not provide a treatment hierarchy. The process and quality of the guideline drafting process will be assessed
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