Fibromyalgia in Severe Functional Disability or Sick-Leave: What Is the Treatment?

When fibromyalgia results in severe functional disability — or has led to sick-leave — individual therapies tend to deliver limited benefit. This clinical situation calls for a more integrated, coordinated approach with evidence behind it.

Clinical scenarioPatients presenting with fibromyalgia and severe disability or sick-leave, where individual therapies alone have not been sufficient. Evidence from comparative trials favours multimodal over single-modality care in this population.

Treatment goalsMeaningful reduction in fibromyalgia-related pain and fatigue.

Approach (partial)The protocol centres on a multimodal rehabilitation programme that brings together exercise and several other therapeutic components. The complete combination, sequencing, and individualisation criteria are in the full regimen.

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References

DOI: 10.1136/annrheumdis-2016-209724

Multimodal rehabilitation ('weak for') programmes should be considered for those with severe disability — in comparison to individual therapies, those that were multimodal improved a range of short-term outcomes.

Most included different combinations of exercise (land and/or water based); education; relaxation; and/or some other specific therapeutic component (eg, Tai Chi; or massage).

In a meta-analysis of nine trials and 1119 patients, multicomponent therapy was effective in reducing pain (−0.37; −0.62 to −0.13), and fatigue, immediately post treatment, compared with waiting list, relaxation, treatment as usual and education.

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