Chronic Multisymptom Illness CMI

Publication Date: April 30, 2021
Last Updated: March 14, 2022

Recommendations

Treatment of CMI

a. Pharmacotherapy

1. We recommend against the long-term use of opioid medications for the management of chronic pain in patients with CMI. (Strong against)
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2. We recommend against offering mifepristone for patients with CMI. (Strong against)
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b. Behavioral Health

3. We suggest offering cognitive behavioral therapy for CMI and symptoms consistent with fibromyalgia, irritable bowel syndrome, or myalgic encephalomyelitis/chronic fatigue syndrome. (Weak for)
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4. We suggest offering mindfulness-based therapies for patients with CMI and symptoms consistent with fibromyalgia, irritable bowel syndrome, or myalgic encephalomyelitis/chronic fatigue syndrome. (Weak for)
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5. There is insufficient evidence to recommend for or against the use of biofeedback modalities in patients with CMI and symptoms consistent with fibromyalgia, irritable bowel syndrome, or myalgic encephalomyelitis/chronic fatigue syndrome. ()
(Neither for nor against)
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c. Complementary and Integrative Health

6. There is insufficient evidence to recommend for or against the use of manual musculoskeletal therapies for patients with CMI and symptoms consistent with fibromyalgia, irritable bowel syndrome, or myalgic encephalomyelitis/chronic fatigue syndrome. ()
(Neither for nor against)
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Treatment of CMI and Symptoms Consistent with FMS or IBS

a. Behavioral Health

7. We suggest considering an emotion-focused therapy for patients with CMI and symptoms consistent with fibromyalgia or irritable bowel syndrome. (Weak for)
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b. Complementary and Integrative Health

8. There is insufficient evidence to recommend for or against offering relaxation therapy for patients with CMI and symptoms consistent with fibromyalgia or irritable bowel syndrome. ()
(Neither for nor against)
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9. There is insufficient evidence to recommend for or against the use of guided imagery and hypnosis modalities in patients with CMI and symptoms consistent with fibromyalgia or irritable bowel syndrome. ()
(Neither for nor against)
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Treatment of CMI and Symptoms Consistent with FMS

a. Pharmacotherapy

10. There is insufficient evidence to recommend for or against offering a trial of mirtazapine, selective serotonin reuptake inhibitors, or amitriptyline for the treatment of pain and improved functional status in patients with CMI and symptoms consistent with fibromyalgia. ()
(Neither for nor against)
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11. We suggest offering a trial of serotonin-norepinephrine reuptake inhibitors for the treatment of pain and improved functional status in patients with CMI and symptoms consistent with fibromyalgia. (Weak for)
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12. We suggest offering pregabalin for the treatment of pain in patients with CMI and symptoms consistent with fibromyalgia. (Weak for)
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13. We suggest against offering nonsteroidal anti-inflammatory drugs for the treatment of chronic pain related to CMI and symptoms consistent with fibromyalgia. (Weak against)
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b. Complementary and Integrative Health

14. We suggest offering yoga or tai chi for patients with CMI and symptoms consistent with fibromyalgia. (Weak for)
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15. We suggest offering manual acupuncture as part of the management of patients with CMI and symptoms consistent with fibromyalgia. (Weak for)
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16. There is insufficient evidence to recommend for or against the use of deep tissue massage modalities in patients with CMI and symptoms consistent with fibromyalgia. ()
(Neither for nor against)
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c. Physical Exercise

17. We suggest offering physical exercise for patients with CMI and symptoms consistent with fibromyalgia. (Weak for)
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Treatment of CMI and Symptoms Consistent with IBS

a. Pharmacotherapy

18. There is insufficient evidence to recommend for or against offering tricyclic antidepressants for the management of gastrointestinal symptoms for patients with CMI and symptoms consistent with irritable bowel syndrome. ()
(Neither for nor against)
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19. There is insufficient evidence to recommend for or against the use of antispasmodics for gastrointestinal symptoms for patients with CMI and symptoms consistent with irritable bowel syndrome. ()
(Neither for nor against)
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20. We suggest offering linaclotide and plecanatide for patients with CMI and symptoms consistent with irritable bowel syndrome with constipation who do not respond to a trial of osmotic laxatives. (Weak for)
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21. There is insufficient evidence to recommend for or against offering lubiprostone for patients with CMI and symptoms consistent with irritable bowel syndrome with constipation who do not respond to a trial of osmotic laxatives. ()
(Neither for nor against)
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22. There is insufficient evidence to recommend for or against offering eluxadoline for patients with CMI and symptoms consistent with irritable bowel syndrome with diarrhea. ()
(Neither for nor against)
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23. We suggest offering a 14-day course of rifaximin for gastrointestinal symptoms for patients with CMI and symptoms consistent with irritable bowel syndrome without constipation. (Weak for)
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24. There is insufficient evidence to recommend for or against offering soluble fiber supplements for gastrointestinal symptoms for patients with CMI and symptoms consistent with irritable bowel syndrome. ()
(Neither for nor against)
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25. There is insufficient evidence to recommend for or against offering alosetron for gastrointestinal symptoms for patients with CMI and symptoms consistent with irritable bowel syndrome. ()
(Neither for nor against)
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26. There is insufficient evidence to recommend for or against offering selective serotonin reuptake inhibitors for the management of gastrointestinal symptoms for patients with CMI and symptoms consistent with irritable bowel syndrome. ()
(Neither for nor against)
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b. Behavioral Health

27. There is insufficient evidence to recommend for or against offering psychodynamic therapies for patients with CMI and symptoms consistent with irritable bowel syndrome. ()
(Neither for nor against)
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Treatment of CMI and Symptoms Consistent with ME/CFS

a. Pharmacotherapy

28. There is insufficient evidence to recommend for or against offering duloxetine for patients with CMI and symptoms consistent with myalgic encephalomyelitis/chronic fatigue syndrome. ()
(Neither for nor against)
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29. We recommend against offering stimulants for treatment of fatigue in patients with CMI and symptoms consistent with myalgic encephalomyelitis/chronic fatigue syndrome. (Strong against)
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Recommendation Grading

Overview

Title

Chronic Multisymptom Illness CMI

Authoring Organization

Veterans Health Administration / Department of Defense

Publication Month/Year

April 30, 2021

Last Updated Month/Year

April 1, 2024

Document Type

Guideline

Country of Publication

US

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
119
Literature Search Start Date
September 30, 2013
Literature Search End Date
April 6, 2020