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Exercise recommended for fibromyalgia

The first expert guidelines on the management of fibromyalgia have underlined the importance of non-drug treatment.

The European League Against Rheumatism has issued nine recommendations after trawling through the evidence base.

Heated pool treatment with or without exercise, individually tailored exercise programmes, cognitive behavioural therapy and relaxation, rehabilitation and physiotherapy are beneficial for some patients, the guidelines state.

Drug treatments that can help include antidepressants such as amitriptyline, but steroids and strong opioids are not recommended.

Most importantly, a combination of treatments tailored to the individual patient will be needed for the best results, the guidelines state.

Dr Serena Carville, clinical trial lead at the academic rheumatology unit at King's College London and guideline group leader, said the aim was to get rid of some of the misconceptions around the condition.

‘We wanted to highlight the fact that while there are medications there's also a lot of non-pharmacological treatment.

'There is a tendency to shy away from exercise but non-pharmacological treatment is equally important.

‘There has not been any guidance and there's no treatment specifically licensed for fibromyalgia in the UK – in the past it's been quite a neglected area.'

But Dr Adam Bajkowski, a GP in Wigan and president of the Primary Care Rheumatology Society, was sceptical that the guidelines would improve GP management of the condition because the main problem was diagnosing it in the first place.

‘The medical profession tends to fall into two categories – those who believe fibromyalgia exists as an independent disease and those who are a bit more sceptical, and I probably fall into the latter.

‘In some ways it's very much like IBS. It's often a diagnosis of exclusion and very often you spend a lot of time telling patients what they haven't got rather than what they have got.'

The guidelines are published in the Annals of Rheumatic Diseases.

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