Dr. Fitzcharles, <i>et al</i> reply

Fitzcharles, Mary‐Ann; Ste-Marie, Peter A.; Shir, Yoram

doi:10.3899/jrheum.130446

Cited by 4 publications

(5 citation statements)

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“…The Guidelines were developed at the request of the Canadian Pain Society (CPS) to provide guidance for the diagnosis, management and patient trajectory of adults with FM in Canada, and the full document is available online through the CPS website (3). Because previous guidelines from the international community were based on available literature up to December 2006, updated guidance was needed in the light of recent progress in the understanding of FM (7)(8)(9).…”

Section: Process Of Guideline Developmentmentioning

confidence: 99%

“…None of the funding sources had a role in the collection, analysis or interpretation of the data, or in the decision to publish the present report. Conflicts of interest for all members of the CFCG have been declared and are listed in the Guidelines document available online (3). the diagnosis of FM reflects a paradigm shift FM should now be positively diagnosed in the primary care setting following a comprehensive clinical evaluation and without need for unnecessary investigation.…”

Section: Process Of Guideline Developmentmentioning

confidence: 99%

See 1 more Smart Citation

2012 Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome: Executive Summary

Fitzcharles

Ste-Marie²,

Goldenberg³

et al. 2013

Pain Research and Management

Self Cite

351

286

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Section: Process Of Guideline Developmentmentioning

confidence: 99%

Section: Process Of Guideline Developmentmentioning

confidence: 99%

2012 Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome: Executive Summary

Fitzcharles

Ste-Marie²,

Goldenberg³

et al. 2013

Pain Research and Management

Self Cite

351

286

View full text Add to dashboard Cite

show abstract

“…The purpose of physical examination and laboratory investigations is to rule out alternative diagnoses, and thus, standard laboratory tests are normal. A full blood count, erythrocyte sedimentation rate, C-reactive protein, creatine phosphokinase, and thyroid stimulating hormone are tests recommended by diagnostic guidelines for FM [ 107 ] as well as CFS [ 108 ]. However, when investigated in research studies, evidence for low grade systemic inflammation can be detected in many patients with PQ conditions.…”

Section: Immune Systemmentioning

confidence: 99%

Programmed Symptoms: Disparate Effects United by Purpose

Gracely¹,

Schweinhardt

2015

CRR

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Central sensitivity syndromes (CSS) share features of similar multiple symptoms, virtually unknown mechanisms and lack of effective treatments. The CSS nomenclature was chosen over alternatives because it focused on a putative physiological mechanism of central sensitization common to disorders such as fibromyalgia, irritable bowel syndrome, vulvodynia and temporomandibular disorder. Increasing evidence from multiple biological systems suggests a further development. In this new model central sensitization is part of a ensemble that includes also the symptoms of widespread pain, fatigue, unrefreshing sleep and dyscognition. The main feature is an intrinsic program that produces this ensemble to guide behavior to restore normal function in conditions that threaten survival. The well known “illness response” is a classic example that is triggered in response to the specific threat of viral infection. The major leap for this model in the context of CSS is that the symptom complex is not a reactive result of pathology, but a purposeful feeling state enlisted to combat pathology. Once triggered, this state is produced by potential mechanisms that likely include contributions of the peripheral and central immune systems, as well as stress response systems such as the autonomic system and the hypothalamic–pituitary–adrenal (HPA) axis. These act in concert to alter behavior in a beneficial direction. This concept explains similar symptoms for many triggering conditions, the poorly understood pathology, and the resistance to treatment.

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“…63 The evidence on the effectiveness of the fibromyalgia pharmacotherapy was, therefore, determined based on significant improvement in the outcomes for each medicine evaluated in relation to the placebo confirmed by metaanalysis. 9,10 In this overview, in common with Canadian and Israeli guidelines, the European League Against Rheumatism (EULAR) recommendations, and the last Brazilian consensus, [63][64][65][66] we find evidence that supports the efficacy of the milnacipran, duloxetine, and pregabalin for a minority of patients in the treatment of pain in fibromyalgia. 18,19,22,24 Pirlindole showed a moderate effect to reduce pain compared to placebo.…”

Section: Discussionmentioning

confidence: 69%

Effect of pharmacotherapy on fibromyalgia: an overview of systematic reviews

et al. 2022

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Fibromyalgia is a debilitating and chronic pain processing disorder, in which the proportion of patients who achieve good results with pharmacotherapy is small. However, choosing the best available evidence on pharmacotherapy can optimize patient clinical outcomes. Objective: This overview aimed to identify in systematic reviews the effects of pharmacotherapy on fibromyalgia, considering the quality of the reviews and the efficacy of the outcomes. Methods: This search was performed in seven databases: PubMed, Web of Science, COCHRANE, Lilacs, Embase, Scopus and IPA. The methodological quality was evaluated using A MeaSurement Tool to Assess Systematic Reviews 2. The protocol was registered in the PROSPERO database (CRD42018095943). Results: A total of 63 systematic reviews were selected after reading full texts, but only 8 of them were of moderate to high quality and were included in this overview. All included reviews were published in English, between 2012 and 2018, performed meta-analysis, used the American College of Rheumatology (1990) diagnostic criteria for fibromyalgia, and jointly assessed pain improvement, adverse reactions, and withdrawal. Most reviews included only randomized controlled trials. Of the fourteen drugs addressed in systematic reviews evaluated, duloxetine, milnacipran, and pregabalin showed evidence of improvement in pain (Moderate:≤30%) and other fibromyalgia symptoms, as depression and fatigue. However, these medications presented significant withdrawals due to adverse reactions (mainly nausea, headache, dizziness and constipation). The rate of treatment withdrawal reached 36%. Conclusion: Few studies have high quality and sufficient evidence on the effect of medicines on fibromyalgia, resulting in a lack of support for prescribers to choose drugs that meet criteria for need, effectiveness, safety and compliance.

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Dr. Fitzcharles, et al reply

Cited by 4 publications

References 4 publications

2012 Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome: Executive Summary

2012 Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome: Executive Summary

Programmed Symptoms: Disparate Effects United by Purpose

Effect of pharmacotherapy on fibromyalgia: an overview of systematic reviews

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