From the Guidelines
Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties, affecting approximately 2% of the general population, as noted in the study by 1.
Key Characteristics of Fibromyalgia
- Widespread musculoskeletal pain
- Fatigue
- Sleep disturbances
- Cognitive difficulties
- Heightened pain sensitivity due to abnormal pain processing in the central nervous system, often described as "central sensitization"
Diagnosis and Management
The diagnosis of fibromyalgia often takes more than 2 years, with an average of 3.7 consultations with different physicians, resulting in high healthcare use, as reported in the study by 1. The management of fibromyalgia should aim at improving health-related quality of life, balancing benefit and risk of treatment, and often requires a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities, as recommended by 1.
Treatment Approaches
- Non-pharmacological therapies, such as aerobic and strengthening exercise, cognitive behavioral therapies, and multicomponent therapies, are recommended as the initial management approach, with a strong level of evidence, as noted in the study by 1.
- Pharmacological management, including medications such as amitriptyline, duloxetine, milnacipran, tramadol, and pregabalin, may be considered based on patient need and response to treatment, as recommended by 1.
Priority Questions for Future Research
The study by 1 identified priority questions for future research, including the most effective type of exercise, the effectiveness of combined pharmacological and non-pharmacological approaches, and the characteristics of patients that predict response to specific therapies.
From the Research
Definition of Fibromyalgia
- Fibromyalgia is characterized by chronic widespread pain, fatigue, sleep disturbances, and functional symptoms 2, 3, 4
- It is a syndrome characterized by chronic and widespread musculoskeletal pain, often accompanied by other symptoms such as fatigue, intestinal disorders, and alterations in sleep and mood 4
- Fibromyalgia is a common chronic pain disorder with unclear etiology 5
Clinical Characteristics
- The clinical features of fibromyalgia include chronic, widespread musculoskeletal pain and associated fatigue, sleep disturbances, and other cognitive and somatic symptoms 3
- Back pain is the most frequent comorbidity in fibromyalgia patients, and hypertension, headache, depression, and sleep disorder are also common 5
- Women are more prone to developing the disease than men 4
Diagnosis and Treatment
- A rheumatologist typically makes a diagnosis of fibromyalgia when the patient describes a history of pain spreading in all quadrants of the body for at least three months and when pain is caused by digital pressure in at least 11 out of 18 allogenic points, called tender points 4
- Treatment options for fibromyalgia include pharmacological therapies such as amitriptyline, duloxetine, and pregabalin, as well as non-pharmacological approaches 2, 6
- The efficacy of these treatments varies, with some studies suggesting that pregabalin 450 mg and amitriptyline 25 mg may be effective for reducing pain intensity in adult patients with fibromyalgia 6