A framework for fibromyalgia management for primary care providers.
Fibromyalgia is a chronic widespread pain disorder commonly associated with several symptoms, including fatigue, cognitive dysfunction, stiffness, mood swings and nonrestorative sleep. It is affecting 0.5% to 5% of Western populations. With growing recognition of fibromyalgia by patients and health care professionals, more people are seeking medical help for chronic pain conditions.
Although there is increasing evidence about the underlying pathophysiologic mechanisms involved in fibromyalgia (recently excessive innervation in microvascular tissue of the hands), clinicians may find it difficult to communicate this emerging information to their patients. Also, many clinicians report difficulty in identifying and diagnosing fibromyalgia. Finally, patients with fibromyalgia are sometimes perceived as difficult to treat, as time and resources may be limited for complex presenting problems.
This article summarizes the principles of comprehensive assessment, education, ADL-goal setting, and multimodal treatment. Practical advise includes pharmacological and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), extensive education and most importantly, objective monitoring of treatment response and progress (by means of the FIQ, Fibromyalgia Impact Questionnaire). A practical framework is presented for GP's and allied health professionals through which they can develop a patient-centered treatment program for patients with fibromyalgia > from Arnold et al, Mayo Clin Proc 87 (2012) 488-496. All rights reserved to Elsevier, Inc.
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