From the Guidelines
Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties, involving central sensitization and neurotransmitter imbalances, and is best managed with a multifaceted approach combining medication, lifestyle changes, and therapy. 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. Some key features of fibromyalgia include:
- Widespread musculoskeletal pain
- Fatigue
- Sleep disturbances
- Cognitive difficulties
- Central sensitization, where the brain and spinal cord process pain signals abnormally, amplifying sensations
- Neurotransmitter imbalances in serotonin, norepinephrine, and substance P likely contributing to both pain perception and associated symptoms like fatigue and mood disturbances 1. The diagnosis of fibromyalgia can be challenging, often taking more than 2 years and involving multiple consultations with different physicians, resulting in high healthcare use 1. The treatment of fibromyalgia typically involves a combination of:
- Medications such as duloxetine, milnacipran, pregabalin, and amitriptyline
- Lifestyle changes, including regular moderate exercise and stress management techniques
- Therapy, such as cognitive behavioral therapy and cognitive behavioral therapies 1. It is essential to focus on research priorities to address issues clarifying to whom certain interventions may best be delivered, their effect in combination, matching patients to therapies, and the organization of healthcare systems to optimize outcome 1.
From the Research
Definition of Fibromyalgia
- Fibromyalgia is a syndrome characterized by chronic generalized pain in addition to different symptoms such as fatigue, sleep disturbances, stiffness, cognitive impairment, and psychological distress 2.
- It is a chronic, centralized pain syndrome characterized by disordered processing of painful stimuli 3.
- Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep 4.
- It is a common chronic pain disorder with unclear etiology 5.
- Fibromyalgia is a widespread, chronic pain disorder that includes a complex constellation of somatic and emotional symptoms 6.
Symptoms of Fibromyalgia
- Patients with fibromyalgia have diffuse chronic pain, poor sleep, fatigue, cognitive dysfunction, and mood disturbances 3.
- Symptoms include fatigue, sleep disturbances, stiffness, cognitive impairment, and psychological distress 2.
- Comorbid conditions, such as functional somatic syndromes, psychiatric diagnoses, and rheumatologic conditions may be present 3.
- Back pain, hypertension, headache, depression, and sleep disorder are common comorbidities 5.
Diagnosis of Fibromyalgia
- The Fibromyalgia Rapid Screening Tool is a helpful screening method for patients with diffuse chronic pain 3.
- 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 3.
- Establishing the diagnosis and providing education can reassure patients and decrease unnecessary testing 3.