1813 01 REUMA3 Editoriale - ME/CFS Australia

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66 R. Casale et al.trol associated with a high incidence of side effects.Physical therapy, rehabilitation and alternativetherapies are generally perceived to be more“natural,” to have fewer adverse effects, and insome way, to be more effective. In this contextphysical exercise and multimodal cognitive behaviouraltherapy seem to be the more acceptedand beneficial forms of non pharmacological therapy.Anedoctal evidence and small observationalstudies using physical therapies, show some goodresults.These results are encouraging premises for larger,more systematic and methodologically sound, randomised,controlled clinical trials which will evaluatethe real effectiveness of physical therapymodalities for managing FM.It is clear that, similar to successful treatment ofother disorders, the most efficacious treatment ofFM will combine the major elements of pharmacotherapy,exercise, physical therapy and mmCBT.Evidence that efficacy is inversely related to diseaseduration suggests that this treatment programshould be initiated as quickly as possible after diagnosis.As noted above, multi-modal treatment may succeedfor a number of reasons. The results of recentstudies that have identified distinct subgroups inFM and studies that predict treatment response indicatethat it will be useful, if not essential, to tailorthe choice of treatment components to individualpatients.Current knowledge is beginning to suggest predictioncriteria for treatment success, and future studiesthat include detailed genotyping and phenotypingpromise to vastly increase the ability to matchtreatment packages to patients. Such knowledgewill also identify healthy individuals who are atrisk for developing FM and signal prophylactictreatment in a manner that is similar to current interventionsfor diabetes or heart disease. Currentevidence suggests that CBT, exercise and to a lesserextent, physical therapies will remain importantcomponents in these individualized treatments byplaying a pivotal role in the long-term managementof FM.The need for multimodal therapy in FM comesfrom different sources. It relies on several factors:first, the potential that all patients possess the samemechanistic disorder, but specific patients only respondto specific treatments and the probability ofreceiving this specific treatment is greater when amultidisciplinary approach has been planned; second,pain and dysfunction may be mediated bydifferent mechanisms, and these different mechanismsare targeted by the different therapeuticcomponents; third, specific patients may need tobe exposed to multiple methods to achieve improvement,and such multiple methods are naturallyprovided by multimodal therapies; fourth, theoutcome measures may only assess a subset of therelevant domain of the disorder, and multiplemethods are more likely to target these evaluateddomains.While there seems to be no single best treatmentoption, a multidisciplinary approach combiningthese therapies in a well-balanced program may bethe most promising strategy.Non-pharmacological treatments can be recommendedin the treatment of FM, although in the interestof time or financial restrictions it is essentialto focus medical prescriptions only on those therapiesthat are supported by scientific evidence.SUMMARYFibromyalgia is a complex syndrome associated with significant impairment in quality of life and function and withsubstantial financial costs. Once the diagnosis is made, providers should aim to increase patients’ function and minimizepain. Fibromyalgia patients frequently use alternative therapies, strongly indicating both their dissatisfaction withand the substantial ineffectiveness of traditional medical therapy, especially pharmacological treatments. At present,pharmacological treatments for fibromyalgia have a rather discouraging cost/benefit ratio in terms of poor symptomcontrol and high incidence of side effects. The interdisciplinary treatment programs have been shown to improve subjectivepain with greater success than monotherapy.Physical therapies, rehabilitation and alternative therapies are generally perceived to be more “natural,” to have feweradverse effects, and in some way, to be more effective. In this review, physical exercise and multimodal cognitivebehavioural therapy are presented as the more accepted and beneficial forms of nonpharmacological therapy.Key words - Multimodal cognitive behavioural, rehabilitation, alternative therapies.Parole chiave - Terapia cognitivo-comportamentale, riabilitazione, terapia alternativa.
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