From the Guidelines
Fibromyalgia is diagnosed based on widespread pain lasting at least 3 months, accompanied by symptoms like fatigue, cognitive difficulties, and unrefreshing sleep, with diagnostic criteria focusing on a widespread pain index (WPI) score and symptom severity scale (SSS) score, as outlined in the 2016 diagnostic criteria 1.
Diagnostic Criteria
The diagnostic criteria for fibromyalgia involve a combination of clinical evaluation and patient-reported symptoms. The 2016 diagnostic criteria, as mentioned, focus on a widespread pain index (WPI) score of at least 7 and a symptom severity scale (SSS) score of at least 5, or WPI of 4-6 with SSS of at least 9. This approach emphasizes the importance of assessing both the extent of pain and the severity of other symptoms such as fatigue, cognitive difficulties, and unrefreshing sleep.
Treatment Options
Treatment of fibromyalgia involves a multimodal approach, combining medication, exercise, and psychological therapies.
- Medications: First-line medications include duloxetine (30-60mg daily), milnacipran (50-100mg twice daily), or pregabalin (150-450mg daily in divided doses), as supported by high-quality evidence from studies such as those referenced in 1 and 1.
- Non-pharmacological treatments: Equally important are non-pharmacological treatments, including regular aerobic exercise (starting with 10 minutes daily and gradually increasing), cognitive behavioral therapy, and stress management techniques like meditation. These approaches are crucial for improving health-related quality of life and managing symptoms effectively, as highlighted in recommendations from 1 and 1.
- Patient Education: Patient education about the chronic nature of fibromyalgia and the importance of consistent treatment is essential for managing expectations and promoting adherence to treatment plans.
Management Approach
The management of fibromyalgia should aim at improving health-related quality of life, balancing the benefits and risks of treatment, and often requires a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities tailored according to pain intensity, function, associated features (such as depression), fatigue, sleep disturbance, and patient preferences and comorbidities, as recommended in 1. Initial management should focus on non-pharmacological therapies, with pharmacological interventions added as necessary based on patient response and symptom severity.
Given the complexity and heterogeneity of fibromyalgia, treatment should be individualized, with medication adjustments based on symptom response and side effects. Improvement typically occurs gradually over weeks to months, and patients should maintain consistent treatment even after symptom improvement to prevent relapse, emphasizing the need for long-term management strategies and ongoing patient support.
From the FDA Drug Label
Studies F1 and F2 enrolled patients with a diagnosis of fibromyalgia using the American College of Rheumatology (ACR) criteria (history of widespread pain for 3 months, and pain present at 11 or more of the 18 specific tender point sites).
The diagnostic criteria for fibromyalgia include:
- A history of widespread pain for 3 months
- Pain present at 11 or more of the 18 specific tender point sites, as defined by the American College of Rheumatology (ACR) criteria 2 The treatment options for fibromyalgia include:
- Pregabalin (PO)
- Duloxetine (PO) 3
From the Research
Diagnostic Criteria for Fibromyalgia
- Fibromyalgia is characterized by chronic widespread musculoskeletal pain and associated symptoms such as fatigue, sleep disturbances, and cognitive dysfunction 4, 5.
- The diagnosis of fibromyalgia requires that organic diseases are not causing the symptoms, and systemic and rheumatic diseases can be ruled out by a patient history, physical examination, and laboratory investigations 4.
- The 1990 American College of Rheumatology (ACR) classification criteria have been used in clinical settings, but they are not ideal for individual patient diagnosis 4.
- A diagnosis of fibromyalgia is typically made 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 6.
Treatment Options for Fibromyalgia
- Treatment options for fibromyalgia include pharmacological and non-pharmacological approaches, with the goal of enhancing functional capacities and quality of life, and symptomatic treatment of individual symptoms such as pain, distress, and sleep disturbances 7.
- Combination therapy, such as pregabalin and duloxetine, has been shown to improve multiple clinical outcomes compared to monotherapy 8.
- Conventional medical therapies produce limited benefits, and many patients turn to complementary medicine to manage their symptoms 6.
- Future evaluations should focus on finding the combined pharmacological or non-pharmacological treatment of choice for specific subgroups of patients 7.