From the Guidelines
Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties, affecting approximately 2% of the 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
- Tender points throughout the body, particularly in areas like the neck, shoulders, back, hips, arms, and legs
- Associated features include depression, anxiety, sleep disturbance, headache, migraine, variable bowel habits, diffuse abdominal pain, and urinary frequency, as outlined in the study by 1.
Treatment Approach
The management of fibromyalgia should aim at improving health-related quality of life, balancing benefit and risk of treatment, often requiring a multidisciplinary approach with a combination of non-pharmacological and pharmacological treatment modalities, as recommended by 1.
- Non-pharmacological management:
- Aerobic and strengthening exercise
- Cognitive behavioral therapies
- Multicomponent therapies
- Defined physical therapies: acupuncture or hydrotherapy
- Meditative movement therapies (qigong, yoga, tai chi) and mindfulness-based stress reduction
- Pharmacological management:
- Amitriptyline (at low dose)
- Duloxetine or milnacipran
- Tramadol
- Pregabalin
- Cyclobenzaprine
Recent Recommendations
The most recent study by 1 suggests offering cognitive-behavioral therapy, mindfulness-based therapies, and considering an emotion-focused therapy for patients with fibromyalgia, as well as offering a trial of serotonin-norepinephrine reuptake inhibitors, pregabalin, yoga, or tai chi for the treatment of pain and improved functional status. However, the single most recent and highest quality study 1 prioritizes a multifaceted approach, including medications and non-pharmacological interventions, to manage fibromyalgia, focusing on improving quality of life and reducing symptoms.
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).
Fibromyalgia is a condition characterized by widespread pain that lasts for at least 3 months, and is present in at least 11 of the 18 specific tender point sites, as defined by the American College of Rheumatology (ACR) criteria 2.
- The diagnosis of fibromyalgia is based on a history of widespread pain and the presence of tender points.
- The condition is often associated with other symptoms, but the FDA drug label does not provide a comprehensive definition of fibromyalgia beyond the ACR criteria.
From the Research
Definition of Fibromyalgia
- Fibromyalgia is a chronic pain disorder characterized by widespread pain, fatigue, and sleep disturbances 3.
- It is a chronic disorder characterized by widespread pain and tenderness, accompanied by disturbed sleep, chronic fatigue, and multiple additional functional symptoms 4.
- Fibromyalgia is a chronic disorder characterized by multifocal pain and other associated somatic symptoms including fatigue, insomnia, cognitive/memory problems, and even psychological distress 5.
- 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 6.
- Fibromyalgia is a syndrome characterized by chronic widespread musculoskeletal pain, which may or may not be associated with muscle or joint stiffness, accompanied by other symptoms such as fatigue, sleep disturbances, anxiety, and depression 7.
Key Characteristics
- Widespread pain in all quadrants of the body for at least three months 6.
- Pain caused by digital pressure in at least 11 out of 18 allogenic points, called tender points 6.
- Fatigue, sleep disturbances, anxiety, and depression are common symptoms 7.
- Central sensitization, peripheral sensitization, and inflammatory and immune mechanisms are underlying processes in fibromyalgia 7.
Diagnosis and Treatment
- Diagnosis is challenging due to the lack of specific diagnostic biomarkers 7.
- Diagnostic approaches have evolved based on the use of scales and questionnaires for pain identification 7.
- Treatment is multidisciplinary, involving both pharmacological and non-pharmacological interventions aimed at alleviating symptoms 7.
- Non-pharmacological treatments include physiotherapy interventions, physical exercise, electrotherapy, and manual therapy 7.