Fibromyalgia (FM) Recommendations Vary By Country

Canada has no alternative (CAM) FM treatment recommendations but Isreali and German Recommendations do..

Ablin, Jacob, Mary-Ann Fitzcharles, Dan Buskila, Yoram Shir, Claudia Sommer, and Winfried Häuser.
Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies.
Evidence-Based Complementary and Alternative Medicine 2013 (2013)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860136/pdf/ECAM2013-528952.pdf

Canadian standards say there is not enough info to recommend CAMS. They recommend:

  • primary care physician handle – I would agree with that – rheumatologists give them amitriptyline and hustle them out of office as fast as can it seems….
  • multidisciplinary team or team member to provide support
    and reassurance. – there can be a several year wait for pain clinics and we only have a block clinic here
  • referral to a sleep specialist or psychologist maybe
  • Usual meds

German recommendations included:

  • increase physical, mental, and social activities for mild
  • aerobic exercise; “timely limited psychological care”, and or drug therapy

  • “day clinic or inpatient multicomponent therapy including psychotherapeutic  and/or psychiatric therapy of mental comorbidities” for severe – we did have a program for severe chronic pain cases but it was shut down for lack of funding.  Psychiatrists seem to have very little training in dealing with FM patients.

Israeli recommendations are step-wise:

Step 1
(i) Education on cause and treatments
(ii)  graded aerobic exercise
(iii) hydrotherapy/aquatic exercise.
(iv) low dose amitriptyline 10–25 mg at bedtime.
(v) cognitive-behavioral treatment.
Step 2
Recommendations included in step 2 are based on a
reassessment of the fibromyalgia patient’s condition, about 12
weeks after initiating treatment.
(i)  amitriptyline/fluoxetine mix or duloxetine (Cymbalta)  (also milnacipran but not available in Canada and not that good if you ask me…)
(ii) Start treatment with pregabalin (Lyrica) to improve sleep
quality and reduce pain.
(iii)  balneotherapy.
(iv)  Tai Chi and Yoga.

Comment – Canadian recommendation lag and don’t take into consideration realities of treatment availabilities. I like the Israeli recommendations but unfortunately we don’t have a Dead sea for balneotherapy… maillot de foot pas cher maillot de foot pas cher

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