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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; Abhishek, Abhishek; Branco, Jaime; da Silva, José A.P.; Taylor, Ann M.

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Burak Kundakci

Michelle Hall

Fabiola Atzeni

Jaime C. Branco

Dan Buskila

Daniel Clauw

Leslie J. Crofford

Mary Ann Fitzcharles

Robert D. Gerwin

Eva Kosek

Gary J. Macfarlane

Caroline Neal

Nathan J. Rudin

Sarah Ryan

José AP da Silva

Ann Taylor

Dennis C. Turk

Daniel Whibley

Michael Doherty

Jaime Branco

José A.P. da Silva

Ann M. Taylor


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.

Journal Article Type Article
Acceptance Date Sep 22, 2022
Online Publication Date Sep 29, 2022
Publication Date 2022-12
Deposit Date Oct 19, 2022
Publicly Available Date Oct 21, 2022
Journal Seminars in Arthritis and Rheumatism
Print ISSN 0049-0172
Electronic ISSN 1532-866X
Publisher Elsevier BV
Peer Reviewed Peer Reviewed
Volume 57
Article Number 152101
Keywords Anesthesiology and Pain Medicine; Rheumatology
Public URL
Publisher URL


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