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Fibromyalgia Non-Pharmacological Treatment — FRCA Final MCQ

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ModeratePain MedicineFibromyalgia Non-Pharmacological TreatmentFRCA Final

A 35-year-old woman (ASA I) presents to the pain clinic with a 1-year history of widespread pain, fatigue, sleep disturbance, and cognitive dysfunction. She meets the ACR 2010 criteria for fibromyalgia. She has tried amitriptyline and duloxetine without benefit. According to NICE NG193, which non-pharmacological treatment has the strongest evidence?

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Correct answer: E — Hydrotherapy only

NICE NG193 (2021) recommends supervised group exercise (aerobic and strengthening) as the non-pharmacological intervention with the strongest evidence for fibromyalgia. It reduces pain, improves function, and enhances quality of life. Other recommended non-pharmacological options include: psychological therapy (CBT or acceptance and commitment therapy), acupuncture (weak recommendation), and multicomponent treatments. Importantly, NICE NG193 controversially recommends AGAINST initiating any analgesic medication (including paracetamol, NSAIDs, opioids, and gabapentinoids) for chronic primary pain – though antidepressants may be considered for their independent pain-modulating effects.

Reference: NICE – 2021 – NG193 Chronic pain; EULAR – 2017 – Fibromyalgia management