From the Research
Fibromyalgia diagnosis should be based on a comprehensive clinical assessment, considering chronic widespread pain lasting at least 3 months, accompanied by symptoms like fatigue, non-restorative sleep, and cognitive difficulties, as recommended by the most recent guidelines 1. The diagnostic criteria for fibromyalgia according to the National Institute for Health and Care Excellence (NICE) guidelines prioritize a comprehensive clinical assessment over specific tests. Key symptoms include:
- Chronic widespread pain lasting at least 3 months
- Fatigue
- Non-restorative sleep
- Cognitive difficulties Management should follow a person-centered approach with shared decision-making, focusing on non-pharmacological treatments such as:
- Supervised physical activity programs (aerobic exercise and strength training)
- Psychological therapies (CBT or acceptance and commitment therapy) Pharmacological options may include:
- Amitriptyline (10-50mg at night)
- Duloxetine (30-60mg daily)
- Pregabalin (150-450mg daily in divided doses)
- Cyclobenzaprine (5-10mg at night) for significant sleep disturbance It is essential to note that strong opioids, NSAIDs, and anti-epileptics (except pregabalin) are not recommended due to limited evidence and potential harms, as highlighted in recent studies 1, 2, 3. Treatment should be reviewed regularly, with medication trials lasting 3-6 months before reassessment. Patient education about the condition is crucial, emphasizing that fibromyalgia is a real but non-progressive disorder that can be managed effectively with appropriate interventions. A multidisciplinary approach involving physiotherapists, psychologists, and pain specialists often yields the best outcomes for this complex condition.