International, multidisciplinary Delphi consensus recommendations on non-pharmacological interventions for fibromyalgia, 2022, Kundakci et al

[Andy]

Highlights

• Although non-pharmacological interventions are recommended as first-line treatment for fibromyalgia, there are currently no evidence-based recommendations as to which intervention(s) to offer as core and adjunctive treatments for each common symptom in fibromyalgia.

• This Delphi exercise provided an evidence-based consensus of international expert practitioners and researchers on core and adjunctive non-pharmacological treatments for pain, fatigue, sleep, and depression in fibromyalgia. Aerobic exercise, education, sleep hygiene and cognitive behavioural therapy were recommended as core treatments for all symptoms.

• This consensus will help clinicians to personalise the treatment plan for people with fibromyalgia according to their symptom(s).

Abstract

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.

Open access, https://www.sciencedirect.com/science/article/pii/S0049017222001524

 

[Trish]

This Delphi exercise provided an evidence-based consensus of international expert practitioners and researchers on core and adjunctive non-pharmacological treatments for pain, fatigue, sleep, and depression in fibromyalgia. Aerobic exercise, education, sleep hygiene and cognitive behavioural therapy were recommended as core treatments for all symptoms.

The Delphic oracle has spoken. CBT, exercise and sleep hygiene are the treatments for everything that involves pain and/or fatigue. I don't know why they bothered to consult the oracle, the answer is always the same.

Definitions of Delphic oracle. (Greek mythology) the oracle at Delphi where a priestess supposedly delivered messages from Apollo to those who sought advice; the messages were usually obscure or ambiguous.

 

[Peter T]

I have not checked with the actual article but I am not convinced that evidence for a consensus on treatment approaches amongst pre selected specialists is the same as those treatment approaches being evidence based.

I suspect that a consensus of experts two hundred years ago would have supported some treatments that all now eschew, including leeches.

There seem to be a number of assumptions in the abstract.

 

[rvallee]

Have given up a looooooong time ago. Just the same mindless crap over and over again.

In what world do these people think "education" on nonsense is treatment? And the continuing obsession with magical "sleep hygiene" again?

Can't even say "at least you tried". This is phoning in phoning it in and simply not caring about anything. It's seriously nihilistic medicine, just completely indifferent to the people it's supposed to serve and unable to even pretend to care beyond ticking a few checkboxes. Awful.

 

[rvallee]

This bit is especially delusional and frankly devious:

This consensus will help clinicians to personalise the treatment plan for people with fibromyalgia according to their symptom(s).

Exactly as "personalized" as a fortune cookie or a psychic séance. Without the lies none of this would work but still: the damn lying all the time, so many lies, damned lies and statistics.

 

[Sean]

Delphi consensus isn't exactly proving useful. IMHO.

 

[shak8]

Wow, oracle!

Seventeen experts said yes or no to the surveyor's choice of non-pharma modalites such as magnetotherapy, cupping, acupuncture, and the usual suspects: the memes of aerobic exercise, mindfulness (don't you love it), and sleep hygiene.

why the emphasis on non-pharma? Got a problem with that?


Non-pharma isn't going to cut with sleep issues. That requires a prescription med.
And often pain does, too, non-opioid preferred, of course.

The supplementary materials at the end of the research article show the actual survey.

 

[Milo]

Rejected interventions were mainly complementary and alternative medicines (CAMs) that had low effect size.[8] On the other hand, some interventions with reported significant improvements such as acupuncture, balneotherapy or weight loss(8) were not recommended. A possible explanation for this may be lack of access to these interventions, cost considerations or potentially unconscious bias against this kind of intervention by members of the Delphi panel who were predominantly physicians. A study assessing cross-cultural differences in GPs’ attitudes towards CAM indicated that many GPs in Germany and the United Kingdom are prejudiced against using them and concerned about its availability.

Wow. They are disappointed that weight loss, acupuncture and bath therapy did not make the cut despite scientific literature pointing to 'significant improvements'. Could it be that in real life, the effect is blunted?