From the Guidelines
Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties, with a prevalence of 2% in the general population, often taking over 2 years to diagnose and requiring a comprehensive assessment of pain, function, and psychosocial context 1.
Key Characteristics
- Widespread musculoskeletal pain
- Fatigue
- Sleep disturbances
- Cognitive difficulties
- Central sensitization leading to abnormal pain processing
Diagnosis and Management
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 tailored according to pain intensity, function, associated features, and patient preferences and comorbidities 1.
Treatment Approaches
- Non-pharmacological management is recommended as the initial approach, including aerobic and strengthening exercise, cognitive behavioral therapies, multicomponent therapies, and meditative movement therapies 1.
- Pharmacological management may include amitriptyline, duloxetine, milnacipran, tramadol, and pregabalin, with the choice of medication depending on patient need and response 1.
Lifestyle Modifications
- Regular gentle exercise, starting with 5-10 minutes daily and gradually increasing
- Cognitive behavioral therapy and stress management techniques
- Consistent sleep schedules and good sleep hygiene
- Diet modifications, such as reducing processed foods and inflammatory triggers
- Pain management strategies, such as heat therapy, gentle massage, and pacing activities throughout the day
From the Research
Definition and Characteristics of Fibromyalgia
- Fibromyalgia is a chronic, centralized pain syndrome characterized by disordered processing of painful stimuli 2
- It is a common chronic pain disorder with unclear etiology 3
- Fibromyalgia is diagnosed more frequently in women and occurs globally, affecting 2% of people in the United States 2
- Patients with fibromyalgia have diffuse chronic pain, poor sleep, fatigue, cognitive dysfunction, and mood disturbances 2, 4
Symptoms and Comorbidities
- Back pain is the most frequent comorbidity in fibromyalgia patients, followed by hypertension, headache, depression, and sleep disorder 3
- Comorbid conditions, such as functional somatic syndromes, psychiatric diagnoses, and rheumatologic conditions may be present 2
- Fibromyalgia is commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep 4
Diagnosis and Management
- The Fibromyalgia Rapid Screening Tool is a helpful screening method for patients with diffuse chronic pain 2
- 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 2
- A multidisciplinary approach that incorporates nonpharmacologic therapies and medications to address problematic symptoms is most effective 2, 4
- Patient education, exercise, and cognitive behavior therapy can improve pain and function 2
- Duloxetine, milnacipran, pregabalin, and amitriptyline are potentially effective medications for fibromyalgia 2, 5