From the Guidelines
Fibromyalgia diagnosis and treatment should prioritize a multimodal approach, combining medication, exercise, and psychological therapies, with a focus on improving health-related quality of life and balancing benefit and risk of treatment, as recommended by the most recent guidelines 1. The diagnostic criteria for fibromyalgia involve widespread pain lasting at least 3 months, accompanied by symptoms like fatigue, cognitive difficulties, and unrefreshing sleep.
Key Diagnostic Criteria:
- Widespread pain index (WPI) score of at least 7 and symptom severity scale (SSS) score of at least 5, or WPI of 4-6 with SSS of at least 9. Treatment options include:
Medications:
- First-line medications: duloxetine (30-60mg daily), milnacipran (50-100mg twice daily), or pregabalin (150-450mg daily in divided doses) 1.
- Amitriptyline (10-25mg at bedtime) can help with sleep disturbances.
Non-Pharmacological Treatments:
- Regular aerobic exercise (starting with 10 minutes daily and gradually increasing) 1.
- Cognitive behavioral therapy (8-12 sessions) 1.
- Patient education about pain management strategies.
- Physical therapy, acupuncture, and mindfulness meditation may provide additional benefit. It is essential to individualize treatment, with regular follow-up to assess effectiveness and adjust as needed, considering the patient's preferences, comorbidities, and potential risks and benefits of treatment 1.
From the Research
Diagnostic Criteria for 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.
- 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 3.
- The American College of Rheumatology (ACR) classification criteria have been used in clinical settings, but they are not ideal for individual patient diagnosis 3.
- The Fibromyalgia Rapid Screening Tool is a helpful screening method for patients with diffuse chronic pain 4.
- 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 4.
Treatment Options for 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 4.
- Patient education, exercise, and cognitive behavior therapy can improve pain and function 4.
- Duloxetine, milnacipran, pregabalin, and amitriptyline are potentially effective medications for fibromyalgia 5, 4.
- Nonsteroidal anti-inflammatory drugs and opioids have not demonstrated benefits for fibromyalgia and have significant limitations 4.
- The application of only pharmacological or nonpharmacological treatment is most often not successful, and a tailored treatment with a patient-centered plan can significantly improve the quality of life of patients 2.