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Year 2021 / Volume 28 / Number 4

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Clinical recommendations for rehabilitation of people with fibromyalgia. A narrative review

Rev. Soc. Esp. Dolor. 2021; 28(4): 194-210 / DOI: 10.20986/resed.2021.3932/2021

Iván Cuyul, Matías Contreras, Romualdo Ordoñez, Pablo Neira, Nicolás Maragaño, Alejandra Rodríguez

ABSTRACT

Introduction: Current evidence suggests non-pharmacological management as the first line of treatment for people with fibromyalgia. However, reviews with an emphasis on clinical applicability are rare.
Objective: To describe evidence-based clinical recommendations for the rehabilitation of people with Fibromyalgia.
Methods: Medline, Web of Science and, Scielo databases were electronically searched for each of the sections of this review. Different search strategies were carried out with the combination of MESH terms and keywords. Primary and secondary studies published in English or Spanish in peer-reviewed journals were included.
Results: Health professionals must know contemporary theoretical aspects of chronic pain and fibromyalgia to avoid overdiagnosis, stigmatization, and persistence of symptoms by professional instruction. A multidimensional clinical assessment with objective and subjective evaluations in a positive context with an emphasis on the construction of a therapeutic alliance facilitates shared decision-making and the selection of successful intervention strategies. Education is the starting point of rehabilitation and its combination with psychological therapy, facilitates active coping and therapeutic adherence. Physical activity and regular exercise are the most evidenced non-pharmacological interventions for improving pain, disability, quality of life, physical function, fatigue, muscle strength, stiffness, sleep, and mood in people with fibromyalgia.
Conclusion: Non-pharmacological approaches are promising in the management of fibromyalgia. This review provides practical recommendations for clinical implementation by interdisciplinary health teams.

RESUMEN

Introducción: La evidencia actual sugiere como primera línea de tratamiento para personas con fibromialgia al manejo no farmacológico. Sin embargo, revisiones con énfasis en la aplicabilidad clínica son escasas.
Objetivo: Describir recomendaciones clínicas basadas en evidencia para la rehabilitación de personas con fibromialgia.
Métodos: Se realizaron búsquedas electrónicas en las bases de datos Medline, Web of Science y Scielo para cada uno de los apartados de esta revisión. Diferentes estrategias de búsqueda fueron realizadas con la combinación de términos MESH y claves. Se incluyeron estudios primarios y secundarios publicados en inglés o español en revistas revisadas por pares.
Resultados: Los profesionales de la salud deben conocer aspectos teóricos contemporáneos del dolor crónico y de la fibromialgia con el fin de evitar el sobrediagnóstico, la estigmatización y la persistencia de los síntomas por instrucción profesional. Una evaluación clínica multidimensional en un contexto positivo, con énfasis en la construcción de alianza terapéutica, facilita la toma de decisiones compartidas y la selección de estrategias de intervención. La educación es el punto de inicio de la rehabilitación y su combinación con terapia psicológica, facilita el afrontamiento activo y la adherencia terapéutica. La actividad física y el ejercicio regular son las intervenciones no farmacológicas con mayor evidencia para mejorar el dolor, discapacidad, calidad de vida, función física, fatiga, fuerza muscular, rigidez, sueño y el estado de ánimo en personas con fibromialgia.
Conclusión: Los abordajes no farmacológicos son prometedores en el manejo de la fibromialgia. Esta revisión aporta recomendaciones prácticas para la implementación clínica por equipos de salud interdisciplinarios.

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Cuyul I, Contreras M, Ordoñez R, Neira P, Maragaño N, Rodríguez A, et all. Clinical recommendations for rehabilitation of people with fibromyalgia. A narrative review. Rev Soc Esp Dolor 2021; 28(4): 194-210 / DOI: 1020986/resed20213932/2021

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