Management of fibromyalgia: practical guides from recent evidence-based guidelines

Abstract

REVIEW ARTICLE Management of fibromyalgia 47pharmacologic therapies. The costs related to FM can be substantial, with over 75% attributed to indirect costs from lost productivity and with in creased costs related to increased severity of FM. 5The concept of FM continues to stimulate de bate amongst researchers and clinicians alike. Advances in the field of functional neuroimaging over the last 2 decades, as well as other lines of physiological experimentation, have highlighted the role of central sensitization (or pain central ization), that is, increased processing of pain, as the main pathogenetic process in FM (and related conditions).6,7 Some authors have reported a more peripheral abnormality with changes consistent Background Fibromyalgia (FM) is a frequent, ex pensive, and controversial condition.1 Studies re port varied prevalence depending on diagnostic criteria used, a country, and a setting. One review reported a global mean prevalence of 2.7% (range, 0.4%-9.3%), with a mean in the Americas of 3.1%, in Europe of 2.5%, and in Asia of 1.7%.2 The prev alence rates of FM in Poland are unknown. FM is more common in women, with a female to male ratio of 3:1 in epidemiology studies 2 and of 8:1 to 10:1 in clinical settings. ABSTRACTFibromyalgia (FM) is a prevalent and costly condition worldwide, affecting approximately 2% of the general population. Recent evidence-and consensus -based guidelines from Canada, Germany, Israel, and the European League Against Rheumatism aim to support physicians in achieving a comprehensive diagnostic workup of patients with chronic widespread (generalized) pain (CWP) and to assist patients and physicians in shared decision making on treatment options. Every patient with CWP requires, at the first medical evaluation, a complete history, medical examination, and some laboratory tests (complete blood count, measurement of C -reactive protein, serum calcium, creatine phosphokinase, thyroid--stimulating hormone, and 25 -hydroxyvitamin D levels) to screen for metabolic or inflammatory causes of CWP. Any additional laboratory or radiographic testing should depend on red flags suggesting some other medical condition. The diagnosis is based on the history of a typical cluster of symptoms (CWP, nonrestorative sleep, physical and/or mental fatigue) that cannot be sufficiently explained by another medical condition. Optimal management should begin with education of patients regarding the current knowledge of FM (including written materials). Management should be a graduated approach with the aim of improving health -related quality of life. The initial focus should ensure active participation of patients in applying healthy lifestyle practices. Aerobic and strengthening exercises should be the foundation of nonpharmacologic management. Cognitive behavioral therapies should be considered for those with mood disorder or inadequate coping strategies. Pharmacologic therapies may be considered for those with severe pain (duloxetine, pregabalin, tramadol) or sleep disturbance (amitriptyline, c...

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