Evidence map›Paper›PMID 27377815›Full record

ReviewAnnals of the rheumatic diseases2017

EULAR revised recommendations for the management of fibromyalgia.

G J Macfarlane, C Kronisch, L E Dean, F Atzeni, W Häuser, E Fluß, E Choy, E Kosek, K Amris, J Branco and 9 more

13 registry-linked trialsOpen access · bronzeAbstract readReview
PubMed Publisher
In one paragraph

Review in Annals of the rheumatic diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 13 registered trials, which are not on this map. Cited by 629 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
629citing papers in PubMed, 18 pooled it
58.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02859467 nasuspendednot on this map

Benefits of Kinesio Taping and Inhibitory Treatment Techniques in Patients With Fibromyalgia Syndrome

TypeinterventionalSponsorUniversidad de AlmeriaRan2016 to 2024Enrolled64ConditionsFibromyalgiaArmsKinesio Taping and Inhibitory Treatment Techniques, Exercise and Electrical Stimulation Therapy
NCT02864524 naunknown statusnot on this map

Effects of Manipulative Therapy in the Lower Thoracic and Cervical Spine in Subjects With Fibromyalgia Syndrome

TypeinterventionalSponsorUniversidad de AlmeriaRan2016 to 2021Enrolled64ConditionsFibromyalgiaArmsManipulative and Massage Therapy, Exercise Program
NCT03347669 naunknown statusnot on this map

A Pilot Study of Small Fiber Neuropathy Prevalence in Fibromyalgia Patients Compared to Healthy Subjects Using Sudoscan®

TypeinterventionalSponsorUniversity Hospital, Clermont-FerrandRan2017 to 2018Enrolled100ConditionsFibromyalgiaArmsSudoscan®
NCT03924960 nacompletednot on this mapstarted 2019, after this paper: background citation

Effectiveness of High-intensity Interval Training Combined With Resistance Training in Patients With Fibromyalgia

TypeinterventionalSponsorHitit UniversityRan2019 to 2020Enrolled55ConditionsFibromyalgiaArmsHigh-intensity interval training, Moderate-intensity continuous training, Control
NCT04673058 nacompletednot on this mapstarted 2021, after this paper: background citation

Effectiveness of Spinal Manipulation in Addition to Standard Pharmacological Treatment in Fibromyalgia : A Blinded Randomized Clinical Trial

TypeinterventionalSponsorBezmialem Vakif UniversityRan2021 to 2021Enrolled60ConditionsFibromyalgiaArmsSpinal Manipulation, Sham Manipulation
NCT04855851 nacompletednot on this mapstarted 2022, after this paper: background citation

Effectiveness of Pain Neuroscience Education and Strength Training Program in Patients With Fibromyalgia

TypeinterventionalSponsorManuel Rebollo SalasRan2022 to 2025Enrolled60ConditionsFibromyalgiaArmsPAIN NEUROSCIENCE EDUCATION AND STRENGTH TRAINING, USUAL CARE
NCT05993663 naunknown statusnot on this mapstarted 2023, after this paper: background citation

Museums as Health Spaces: Design and Evaluation of the Effectiveness of an Arts in Health Intervention to Improve the Quality of Life and Functional Capacity Regarding the Pain of People With Fibromyalgia. Mixed Methodology Study.

TypeinterventionalSponsorFundacio d'Investigacio en Atencio Primaria Jordi Gol i GurinaRan2023 to 2025Enrolled121ConditionsFibromyalgiaArmsArts in health group intervention
NCT06226376 nacompletednot on this mapstarted 2024, after this paper: background citation

The Effects of EXOPULSE Mollii Suit on Fibromyalgia Syndrome in Patients With Fibromyalgia (EXOFIB 2): A Sham Controlled Randomized Double-Blind Trial

TypeinterventionalSponsorSheikh Shakhbout Medical CityRan2024 to 2025Enrolled28ConditionsFibromyalgia, Rheumatic Diseases, Muscular Diseases, Neuromuscular DiseasesArmsEXOPULSE Mollii Suit Stimulation
NCT06746922 narecruitingnot on this mapstarted 2025, after this paper: background citation

The Effect of Intermittent Theta Burst Stimulation to the Primary Motor Cortex on Pain Intensity, Pain Catastrophizing, Quality of Life and Mood in Fibromyalgia Patients

TypeinterventionalSponsorIzmir Katip Celebi UniversityRan2025 to 2027Enrolled30ConditionsFibromyalgia, Transcranial Magnetic Stimulation Repetitive, PainArmsIntermittent theta-burst stimulation, Sham Intermittent theta-burst stimulation
NCT07239427 narecruitingnot on this mapstarted 2025, after this paper: background citation

Use of Transcranial Direct Current Stimulation (TDCS) in an Active Pain Coping Program for Patients With Fibromyalgia: A Randomized Control Trial.

TypeinterventionalSponsorUniversity of ValladolidRan2025 to 2026Enrolled68ConditionsFibromyalgiaArmsPain Science Education, Transcranial Direct Current Stimulation, Therapeutic Exercise, Sham Transcranial Direct Current Stimulation
NCT07323199 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

High-Intensity Interval Training (HIIT) and Transcranial Direct Current Stimulation (tDCS) in Women With Fibromyalgia - Effects on Clinical and Neuro-physiological Variables: Randomized Clinical Trial Protocol

TypeinterventionalSponsorUniversidad Nacional Andres BelloRan2026 to 2027Enrolled40ConditionsFibromyalgia (FM)ArmsEXERCISE TRAINING WITH OR WITHOUT MEDICATION, Neuromodulators
NCT07403929 narecruitingnot on this mapstarted 2026, after this paper: background citation

Determination of the Effect of Fermented Grape Juice Consumption on Oxidative Stress and Inflammation Biomarkers and SIRT-1 Levels in Fibromyalgia Patients

TypeinterventionalSponsorHacettepe UniversityRan2026 to 2027Enrolled45ConditionsFibromyalgia, Fibromyalgia (FM), Fibromyalgia Syndrome, PrimaryArmsMedical Nutrition Therapy (MNT), Hardaliye (200 mL/day)
NCT07782255 nacompletednot on this mapstarted 2025, after this paper: background citation

Interdisciplinary Therapeutic Intervention for People With Persistent Pain

TypeinterventionalSponsorPlaya Ancha UniversityRan2025 to 2025Enrolled15ConditionsFybromyalgiaArmsMultimodal Interdisciplinary Therapeutic Intervention
3 · Its place in the literature

Who cites it

629 citing papers in PubMed, 18 syntheses or guidelines pooled it, 1,453 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Pooled it
  14. Guideline
  15. Pooled it
  16. Brain modulatory effects of rehabilitation interventions in fibromyalgia: a systematic review of magnetic resonance imaging studies.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
    Pooled it
  17. Pooled it
  18. Pooled it
  19. Trial
  20. Trial

569 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors at 14 institutions in 12 countries.

G J MacfarlaneEpidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
C KronischEpidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
L E DeanEpidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
F AtzeniICRCCS Galeazzi Orthopaedic Institute, Milan, Italy.
W HäuserDepartment of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany.
E FlußEpidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
E ChoySection of Rheumatology, Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.
E KosekDepartment of Clinical Neuroscience, Karolinska Institutet and Stockholm Spine Centre, Stockholm, Sweden.
K AmrisDepartment of Rheumatology, Bispebjerg and Frederiksberg, The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark.
J BrancoRheumatology Department, CEDOC-NOVA Medical School, UNL, CHLO, Hospital Egas Moniz, Lisbon, Portugal.
F DincerHacettepe University Division of Internal Medicine, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.
P Leino-ArjasFinnish Institute of Occupational Health, Helsinki, Finland.
K LongleyPatient Representative, Bristol, UK.
G M McCarthyMater Misericordiae University Hospital, Dublin, Ireland.
S MakriPatient Representative, Limassol, Cyprus.
S PerrotCentre de la Douleur, Hôpital Cochin-Hôtel Dieu, Université Paris Descartes, Paris, France.
P Sarzi-PuttiniRheumatology Unit, L. Sacco University Hospital, Milan, Italy.
A TaylorInstitute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.
G T JonesEpidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
University of Aberdeen · GBCardiff University · GBAt Bristol · GBCopenhagen University Hospital · DKFinnish Institute of Occupational Health · FIHacettepe University · TRHospital de Egas Moniz · PTIstituto Ortopedico Galeazzi · ITKarolinska Institutet · SELimassol General Hospital · CYLuigi Sacco Hospital · ITMater Misericordiae University Hospital · IETechnical University of Munich · DEUniversité Paris Cité · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'.

methodsA multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.

results2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).

conclusionsThese recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

Indexed as

Activities of Daily LivingPractice Guidelines as TopicSleepAcupuncture TherapyAmitriptylineAnticonvulsantsAntidepressive Agents, TricyclicAnti-Inflammatory Agents, Non-SteroidalBiofeedback, PsychologyCapsaicinCognitive Behavioral TherapyEuropeEvidence-Based MedicineExercise TherapyFatigueFibromyalgiaAmitriptylineAnticonvulsantsAntidepressive Agents, TricyclicAnti-Inflammatory Agents, Non-SteroidalCapsaicincyclobenzaprineHuman Growth HormoneMonoamine Oxidase InhibitorsS-AdenosylmethionineSelective Serotonin Reuptake InhibitorsSensory System AgentsSerotonin and Noradrenaline Reuptake InhibitorsSodium OxybateFibromyalgis/Pain SyndromesMultidisciplinary team-careTreatment

Identifiers

PMID27377815
OpenAlexW2473039652

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

and 7 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.