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

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.