From the Guidelines
Fibromyalgia fits primarily in the category of chronic pain disorders, specifically as a centralized pain syndrome, and is also classified as a functional somatic syndrome and a chronic overlapping pain condition. This classification is based on the understanding that fibromyalgia involves central sensitization, where the central nervous system amplifies painful and non-painful signals, as noted in the EULAR revised recommendations for the management of fibromyalgia 1. The condition is characterized by widespread musculoskeletal pain accompanied by fatigue, sleep disturbances, memory issues, and mood problems, which are common but not universal symptoms, as highlighted in the abstract of the EULAR recommendations 1.
Key Characteristics of Fibromyalgia
- Widespread musculoskeletal pain
- Fatigue
- Sleep disturbances
- Memory issues
- Mood problems
- Central sensitization
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, as recommended by the EULAR guidelines 1. Initial management should focus on non-pharmacological therapies, including aerobic and strengthening exercise, cognitive behavioral therapies, and multicomponent therapies, which have been shown to be effective in improving symptoms and quality of life in patients with fibromyalgia 1.
Treatment Approaches
- Non-pharmacological therapies:
- Aerobic and strengthening exercise
- Cognitive behavioral therapies
- Multicomponent therapies
- Pharmacological therapies:
- Amitriptyline (at low dose)
- Duloxetine or milnacipran
- Tramadol
- Pregabalin
The EULAR guidelines also emphasize the importance of considering patient preferences and comorbidities when selecting treatment modalities, and highlight the need for further research to address the remaining gaps in knowledge, including the identification of characteristics of patients with fibromyalgia that predict response to specific therapies 1. Overall, the management of fibromyalgia requires a comprehensive and individualized approach that takes into account the complex and heterogeneous nature of the condition.
From the FDA Drug Label
The most commonly observed adverse reactions in duloxetine delayed-release capsules-treated patients in all the pooled adult populations (i.e., MDD, GAD, DPNP, FM, OA, and CLBP) (incidence of at least 5% and at least twice the incidence in placebo-treated patients) were nausea, dry mouth, somnolence, constipation, decreased appetite, and hyperhidrosis.
Fibromyalgia fits into the following categories:
- Chronic musculoskeletal pain
- Fibromyalgia (FM)
- Diabetic Peripheral Neuropathic Pain (DPNP) is not a category that fibromyalgia fits into, but it is mentioned alongside FM in the context of duloxetine treatment.
- Chronic Low Back Pain (CLBP) and Osteoarthritis (OA) are also mentioned, but fibromyalgia is not explicitly stated to fit into these categories. 2
From the Research
Categories of Fibromyalgia
Fibromyalgia can be categorized into several areas, including:
- Chronic pain syndromes: Fibromyalgia is characterized by chronic widespread pain, fatigue, sleep disturbances, and functional symptoms 3
- Centralized pain syndromes: Fibromyalgia is a chronic, centralized pain syndrome characterized by disordered processing of painful stimuli 4
- Rheumatologic conditions: Fibromyalgia is often comorbid with rheumatologic conditions, such as arthritis 4, 5
- Psychiatric conditions: Fibromyalgia is often comorbid with psychiatric diagnoses, such as depression and anxiety 4, 5
- Functional somatic syndromes: Fibromyalgia is a type of functional somatic syndrome, characterized by symptoms that cannot be explained by a medical condition 4
- Musculoskeletal conditions: Fibromyalgia is the third most frequent musculoskeletal condition, and its prevalence increases with age 3
Clinical Characteristics
Fibromyalgia can also be categorized based on its clinical characteristics, including:
- Pain characteristics: Fibromyalgia is characterized by chronic widespread pain, which can be debilitating and interfere with daily life 4, 6
- Sleep disturbances: Fibromyalgia is often associated with sleep disturbances, such as insomnia and restless leg syndrome 4, 6
- Fatigue: Fibromyalgia is characterized by persistent fatigue, which can be debilitating and interfere with daily life 4, 6
- Cognitive dysfunction: Fibromyalgia is often associated with cognitive dysfunction, such as memory and concentration problems 4
- Mood disturbances: Fibromyalgia is often comorbid with mood disturbances, such as depression and anxiety 4, 5