Coming up with any treatment guideline for fibromyalgia is difficult, considering that the causes of the condition are unknown. However, years of trial and error have given researchers and medical professionals some idea of what approaches to fibromyalgia treatment work and what ones don’t.
However, there is some discord between guidelines from different countries. In the March 2014 issue of Pain Medicine News, an article compares guidelines for fibromyalgia treatment from three countries: Canada, Israel and Germany.
The author shows that each country’s guideline supports the use of a multimodal approach to fibromyalgia, incorporating different types of treatments such as exercise, education, psychological intervention and, in some cases, medication. The three countries agree that aerobic exercise and cognitive behavioral therapy each get an A grade (the highest level) for evidence in support of its use.
When you look at grades given to medications, that’s where you start seeing discrepancies. The author compares guidelines concerning four types of medication commonly prescribed to manage fibromyalgia pain: Cymbalta (SNRI anti-depressant/neuropathic pain drug), Lyrica (designed to treat neuropathic pain), Elavil (tricyclic anti-depressant) and Savella (SNRI anti-depressant). Elavil is given an A by Canadian and Isreali guidelines, but only a C by the Germans. Cymbalta and Savella also get an A from the Canadians and Isrealis while getting a B/C from the Germans (B if patients present with a comorbid mood disorder, C if not). German guidelines give Lyrica a C, while grades for this drug aren’t noted for the other countries.
The author notes that German guidelines tout the benefits of complementary medicine more than the Canadian or Isreali guidelines. Germany puts yoga, tai chi and relaxation training among the most effective treatment methods with an A grade for each. This more open attitude toward complementary methods may explain the lower grades attributed to medications from German researchers.
See more from the comparative article at www.painmedicinenews.com.
As outlined by the American Academy of Family Physicians, U.S. guidelines agree that a multimodal approach is best. Advice on aerobic training also receives an A. Elavil is designated as having “strong evidence” behind it, while Cymbalta and Lyrica admit of “moderate evidence.” Other treatments in the “strong evidence” category include cognitive behavioral therapy and patient education. In the “moderate evidence” category, we see acupuncture, balneotherapy, biofeedback and hypnotherapy.
Despite this, the University of Maryland Medical Center suggests that many fibromyalgia patients are treated first and foremost with medications. Cochrane Reviews provide a detailed overview of the state of the research into different drugs and offers conclusions as to their effectiveness. See www.thecochranelibrary.com for Cochrane researchers’ summaries on drug and non-drug treatments for fibromyalgia. Turning to medication as a first or primary line of defense seems indefensible considering the following facts: 1) side effects and long-term risks are associated with medications; 2) the evidence suggested by Cochrane is not stellar; and 3) there are comparable or more reliable treatment options such as exercise and alternative therapies that don’t come with the risks associated with medications.
The different ratings given to the same treatment methods by different countries, and a discrepancy between ratings and some research reviews, suggests that clinical guidelines are not always completely reliable or objective. Just because medication is often a first and primary treatment approach doesn’t mean it should be. Patients can protect themselves from inefficient and scientifically unsupported (or poorly-supported) treatments by doing their research and finding a medical professional who will work with them to treat fibromyalgia safely and efficiently.