What is fibromyalgia?

From the Guidelines

Fibromyalgia management should prioritize a multimodal approach, combining non-pharmacological and pharmacological treatments, with a focus on improving health-related quality of life, as recommended by the EULAR revised recommendations for the management of fibromyalgia 1.

Key Recommendations

• Initial management should focus on non-pharmacological therapies, including aerobic and strengthening exercise, cognitive behavioral therapies, and multicomponent therapies, as they have been shown to be effective in improving symptoms and quality of life 1.
• Pharmacological management may include amitriptyline, duloxetine, milnacipran, tramadol, and pregabalin, with the choice of medication depending on the individual patient's needs and preferences 1.
• A graduated approach to management is recommended, with a combination of non-pharmacological and pharmacological treatment modalities tailored to the patient's pain intensity, function, associated features, and comorbidities 1.

Non-Pharmacological Approaches

• Regular moderate exercise, starting with 10 minutes daily and gradually increasing, can help improve symptoms and quality of life 1.
• Cognitive behavioral therapy and stress management techniques, such as meditation or deep breathing exercises, can also be beneficial in managing fibromyalgia symptoms 1.
• Sleep hygiene practices, including maintaining consistent sleep schedules and avoiding caffeine before bedtime, are essential for improving sleep quality and reducing symptoms 1.

Pharmacological Approaches

• First-line medications for fibromyalgia include duloxetine (30-60mg daily), milnacipran (50-100mg twice daily), or pregabalin (150-450mg daily divided into 2-3 doses) 1.
• Amitriptyline (10-25mg at bedtime) can help with sleep and pain, and may be considered as an adjunctive therapy 1.
• Tramadol and cyclobenzaprine may also be considered for pain management, although their use should be carefully weighed against potential risks and benefits 1.

From the Research

Definition and Characteristics of Fibromyalgia

• Fibromyalgia is a chronic condition characterized by generalized musculoskeletal pain associated with other symptoms, especially sleep and mood disorders, fatigue, and cognitive dysfunctions 2.
• It is a chronic, centralized pain syndrome characterized by disordered processing of painful stimuli 3.
• Fibromyalgia is diagnosed more frequently in women and occurs globally, affecting 2% of people in the United States 3.

Diagnosis of Fibromyalgia

• The diagnosis is based on a clinical approach and known diagnostic criteria, while additional methods, such as radiographic, magnetic resonance, or laboratory analyses, can be useful to exclude other conditions 2.
• The Fibromyalgia Rapid Screening Tool is a helpful screening method for patients with diffuse chronic pain 3.
• The American College of Rheumatology criteria or the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy diagnostic criteria can diagnose fibromyalgia 3.

Treatment of Fibromyalgia

• Treatment begins with patient education and involves the simultaneous application of pharmacological and nonpharmacological treatments 2.
• A multidisciplinary approach that incorporates nonpharmacologic therapies and medications to address problematic symptoms is most effective 3.
• Patient education, exercise, and cognitive behavior therapy can improve pain and function 3.
• Duloxetine, milnacipran, pregabalin, and amitriptyline are potentially effective medications for fibromyalgia 3, 4.
• Nonsteroidal anti-inflammatory drugs and opioids have not demonstrated benefits for fibromyalgia and have significant limitations 3.

Clinical Characteristics and Medication Uses

• Back pain is the most frequent comorbidity in fibromyalgia patients, and hypertension, headache, depression, and sleep disorder are also common 4.
• The median daily dose at the start of follow-up was 25 mg for amitriptyline, 60 mg for duloxetine, 300 mg for gabapentin, and 75 mg for pregabalin 4.
• Only one-fifth of patients continued the treatment started for ≥1 year 4.
• Patients who started one of the four common drugs for fibromyalgia similarly had multiple comorbidities and other fibromyalgia-related medication use, but continued the treatment only for a short time 4.