From the Guidelines
Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties, involving abnormal pain processing in the central nervous system, and requires a multifaceted approach for management. The condition affects approximately 2-4% of the population, predominantly women, and involves heightened pain sensitivity, often described as "central sensitization" 1. Patients typically experience tender points throughout their body, particularly in areas like the neck, shoulders, back, hips, arms, and legs. Beyond pain, fibromyalgia commonly causes:
- Sleep problems
- Morning stiffness
- Headaches
- Irritable bowel syndrome
- Anxiety
- Depression While there's no cure, treatment typically involves a multifaceted approach including:
- Medications (such as duloxetine, pregabalin, or milnacipran at gradually increasing doses) 1
- Regular gentle exercise
- Stress management techniques
- Cognitive behavioral therapy The condition is believed to result from a combination of genetic predisposition, environmental triggers like infections or physical trauma, and neurochemical imbalances affecting how the brain processes pain signals 1. Though not life-threatening, fibromyalgia can significantly impact quality of life and requires ongoing management, with a focus on improving health-related quality of life, balancing benefit and risk of treatment, and often requiring 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.
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 for at least 3 months, and pain present at 11 or more of the 18 specific tender point sites, as defined by the American College of Rheumatology (ACR) criteria 2.
From the Research
Definition and Characteristics of Fibromyalgia
- Fibromyalgia is a chronic illness characterized by chronic widespread pain, sleep problems, physical exhaustion, and cognitive difficulties 3.
- It is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep 4.
- Fibromyalgia is a chronic, centralized pain syndrome characterized by disordered processing of painful stimuli 5.
- It 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 6.
Diagnosis and Prevalence
- The American College of Rheumatology (ACR) defined classification criteria that required multiple tender points and chronic widespread pain in 1990, but later revised the criteria in 2010 to exclude tender points and place reliance on patient-reported somatic symptoms and cognitive difficulties 3.
- The Fibromyalgia Rapid Screening Tool is a helpful screening method for patients with diffuse chronic pain 5.
- Fibromyalgia occurs in all populations worldwide, and symptom prevalence ranges between 2% and 4% in the general population 3.
- It is more prevalent in women than in men, and although it can occur at any age, it is more common between the ages of thirty and thirty-five 6.
Treatment and Management
- Current evidence-based guidelines emphasize the value of multimodal treatments, which encompass both non-pharmacological and selected pharmacological treatments tailored to individual symptoms 3.
- A multidisciplinary approach that incorporates nonpharmacologic therapies and medications to address problematic symptoms is most effective 5.
- Patient education, exercise, and cognitive behavior therapy can improve pain and function 5.
- Duloxetine, milnacipran, pregabalin, and amitriptyline are potentially effective medications for fibromyalgia 5.
- Non-pharmacological treatments, such as physiotherapy interventions, physical exercise, electrotherapy, and manual therapy, can also alleviate symptoms 6, 7.