There always is an abundance of posters and abstracts on fibromyalgia at
the international meetings. One has to select a few and leave the rest for more
specific discussions.
[SP0061]
W. Häuser talked about: “FIBROMYALGIA – WHAT REALLY WORKS? FROM ANCIENT
TO RECENT MANAGEMENTS“. He stated: “Multiple systematic reviews of randomised
controlled trials (RCTs) demonstrated that no therapy
(complementary/alternative, drug, physical, psychological) in FM “really works”
in the sense of substantial symptom relief in the majority of patients.“ “…“old
drugs” such as amitryptiline or fluoxetine did not differ from “new” drugs such
as duloxetine, milnacipran and pregabalin in terms of symptom reduction and
tolerability.“ Effects of were comparable to aerobic exercise and cognitive
behavioral therapies, only the latter show evidence of sustained positive
effects after the end of treatment. As there are no predictors, treatment
responders should be treated. “Patients with mild FM do not need a specific treatment.”
Häuser refers to the recent guidelines (Canada, Germany, Israel) and comments
on drug therapy. "A recent study which combined aerobic exercise with
tailored psychological therapies showed promising long-term results.“
Aerobic exercise plus cognitive behavioral therapy has a positive effect
in patients, who allow such treatment. We have been treating patients
successfully in this way at our centre since the late 1990ies and therefore
it’s depressing for me to see one drug study following the next (duloxetine,
milnacipran, and pregabalin) and a lack of studies addressing the issue of
cognitive behavioral therapy plus aerobic exercise. I’m optimistic that this
will change.
A little aside: recently German physicians have been warned about the
risk of addiction to pregabalin.
[SP0125]
F. Mckenna on: “MANAGEMENT OF FIBROMYALGIA”. Very interesting talk. “Current
data [therefore] supports the hypothesis that both fatigue and chronic
widespread pain in FM result from abnormalities in sleep architecture in patients
with psychological vulnerability, leading to dysfunction in the descending pain
regulating system. These data suggest that management of FM should be
multifaceted. In addition to physical, behavioural and other psychological
therapies, treatment programmes must include active management of sleep
pathology.”
Fatigue and sleep have been issues since the beginning of fibromyalgia
research, but pain has been addressed more often than fatigue and sleep. I have
used tips and recommendation as well as discussions with patients.
Please refer to “Recommendations for a sound sleep 2.0” http://rheumatologe.blogspot.de/2013/06/recommendations-for-sound-sleep-20.html
[OP0122]
M.J. Beasley and colleagues presented: “ASSOCIATION BETWEEN ALCOHOL
CONSUMPTION AND CHRONIC WIDESPREAD PAIN: RESULTS FROM A POPULATION-BASED
CROSS-SECTIONAL STUDY“. Conclusions: “Moderate alcohol consumption was
associated with lower CWP (chronic widespread pain) prevalence, and strongly
associated with lower levels of disability in those with CWP. A potential
biological mechanism is alcohol’s agonist effects on the neurotransmitter γ-aminobutyric acid (GABA), and disruptions to GABA pain
inhibitory pathways have been suggested in persons with FM. Further investigation
of the mechanism for these associations is required, specifically whether the
excess of highly disabling pain in lifetime non-drinkers with CWP can be
explained by other lifestyle or psychosocial factors.
The topic fibromyalgia and
alcohol has already been discussed. I’ve written a blogpost on “Fibromyalgia and
Alcohol as a Treatment?” as there had been a study by C.H. Kim and colleagues
with the title: “Association between alcohol consumption and symptom severity
and quality of life in patients with fibromyalgia“; link: http://rheumatologe.blogspot.de/2014/04/fibromyalgia-and-alcohol-as-treatment.html.
[OP0288-PARE]
R. Greiff presented: „PAIN SCHOOL “KNOWLEDGE FOR LIFE” MAKES LIFE EASIER
FOR PEOPLE WITH CHRONIC PAIN“. Conclusions: “… “Knowledge for Life” becomes for
many of the participants with chronic pain/fibromyalgia a turning point in
life. Where there was no hope only despair, there is new belief in their own
abilities.“
[THU0329]
X. Chen and coleagues presented: “PLACEBO EFFECT IN FIBROMYALGIA – A
SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS”
Methods: We searched Medline, PubMed, Web of Science, EMBASE, and
Results: „3375 studies were found from the literature search. After
scrutiny, 204 trials met the inclusion criteria. In total 13,968 participants
were included from all trials, (mean age 49.2 years; 95.4% women).“ … Conclusions: „Although considered a
hard-to-treat condition, people with FM treated with placebo can show
significant improvement in pain and other outcomes. Several variables influence the magnitude of this
effect. Optimisation of such contextual response could have relevance to
clinical care.“
I’ve looked at this problem, too. Here are my ideas: http://rheumatologe.blogspot.de/2012/06/fibromyalgia-and-pregabalin-some-ideas.html
[THU0318]
M.-A. Fitzcharles and colleagues presented: “REAL-LIFE ASSESSMENT OF THE
VALIDITY OF PATIENT GLOBAL IMPRESSION OF CHANGE IN FIBROMYALGIA“. Conclusions: “The
results of this analysis suggest that overall, a weak correlation exists
between PGIC (Patient Global Impression of Change) and improvement in standard
FM outcome measures. Furthermore, FUP (follow-up) duration was identified as a
significant confounder of patient perception of disease improvement which could
be due to recall bias or survival bias. Altogether, these results have
important implications for FM management and designing new instruments
assessing outcomes in FM.”
OK, I’ve made a subjective selection of studies / abstracts, and others
might stress other studies. But I think the EULAR 2014 Meeting showed, that
fibromyalgia still needs research and subsequent consensus. The disparities
between researchers/experts and non-rheumatologists/GPs on what fibromyalgia is
need to be bridged. I am optimistic for the future as scientific proofs on fibromyalgia
accumulate with every meeting.
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