Fibromyalgia is a chronic disorder characterised by widespread pain, tenderness, fatigue, and sleep disturbances. While the exact cause is not fully understood, individuals with fibromyalgia typically exhibit heightened sensitivity to pain.
Management and Treatment
Although there is no cure for fibromyalgia, symptoms can be managed with a multidisciplinary approach that often includes exercise, psychological therapy, behavioural therapy, and medications.
Demographics
- Prevalence: Fibromyalgia can affect anyone but is more common in women than men. It can occur at any age but typically starts in middle age.
- Comorbidities: Individuals with rheumatic diseases, mood disorders, or chronic pain conditions are at higher risk of developing fibromyalgia.
Symptoms
- Chronic, widespread pain
- Fatigue
- Sleep disturbances
- Muscle and joint stiffness
- Tenderness to touch
- Cognitive issues (“fibro fog”)
- Heightened sensitivity to stimuli
- Digestive issues
Causes
- Pain Sensitivity: Individuals with fibromyalgia have heightened sensitivity to pain.
- Neurological Changes: Brain imaging studies show altered signalling in pain-related neural pathways.
- Genetic Factors: Fibromyalgia tends to run in families, suggesting a genetic component.
- Environmental Triggers: Environmental factors, such as diseases causing pain or mental health problems, may contribute to the development of fibromyalgia.
Diagnosis
- Fibromyalgia is recognized as a spectrum disorder, varying in the spatial distribution of pain and symptom severity.
- The concept of “fibromyalgianess” acknowledges its spectrum nature rather than being a discrete disorder.
- Diagnostic criteria have evolved from the original classification, considering the multidimensional aspects of the condition.
Challenges in Diagnosis
- Clinical assessment, especially in general practice, can be challenging due to time constraints.
- Fibromyalgia should be considered in cases of persistent musculoskeletal pain, fatigue, or sleep disturbance disproportionate to background chronic illness severity.
Diagnostic Approach
- Referral to a rheumatologist or pain medicine specialist may be warranted if diagnostic uncertainty exists.
- A validated self-assessment tool (Fibromyalgia survey questionnaire) based on diagnostic criteria has been developed to quantify symptoms.
- Examination for deep tissue tenderness, required by old criteria, is now avoided.
- Investigations are necessary to exclude treatable comorbidities and potential differential diagnoses, such as thyroid dysfunction.
Non-Pharmacological Approaches for Fibromyalgia
Fibromyalgia poses a significant burden on individuals, requiring sustained support for effective self-management. Cognitive dysfunction related to fibromyalgia may make self-management challenging and often goes unrecognised by healthcare professionals.
Effective Intervention Methods
- Group Settings: Self-management skills training is best delivered in small, supportive group settings. These settings allow for education, coping skills training, and cognitive behavioural approaches.
- Peer Mentoring: Trained peer mentors can aid in consolidating self-management skills.
- Communication: Health professionals should adopt an open and patient-centred communication style to support individuals with fibromyalgia.
Exercise and Psychoeducational Approaches
- These approaches have shown the greatest evidence of efficacy among non-pharmacological therapies. Tailoring these interventions to individual needs is crucial.
- Pre-exercise biomechanical assessment and exercise monitoring by a knowledgeable physical therapist are recommended, particularly for moderate to severe cases.
- Promotion of daily physical activity can be facilitated by using an actimeter (exercise diary).
- Referral to a psychologist should be considered for patients experiencing psychological distress.
Pharmacological Approaches for Symptom Management
Pharmacotherapy plays a supportive role in managing fibromyalgia symptoms. Medications should be initiated at low doses and cautiously increased. Selection of medications should be based on the individual’s predominant symptoms, with pain, sleep disturbance, and psychological distress being key targets.
Antidepressants
- Low-dose amitriptyline is traditionally used for pain and sleep disturbance, although evidence supporting its use is of low quality.
- Serotonin noradrenaline reuptake inhibitors like duloxetine and milnacipran may be considered, with moderate efficacy demonstrated in studies.
Antiepileptic Drugs
- Pregabalin and gabapentin target pain facilitatory neurotransmitters and have shown potential pain modulatory effects. Pregabalin may also benefit sleep.
- Pregabalin, although not listed on the Pharmaceutical Benefits Scheme (PBS) for fibromyalgia, may be considered due to its efficacy in neuropathic pain.
Other Drugs
Paracetamol used alone and non-steroidal anti-inflammatory drugs have weak or no evidence of efficacy, respectively.
Additional Insights
- One study indicates that people with endometriosis may be more likely to have fibromyalgia than those without. Symptoms of chronic pain from both conditions can also overlap.
- Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are medically unexplained syndromes that can and often do co-occur. One study found that 34% of 313 people with CFS also had fibromyalgia.
Difference between Polymyalgia Rheumatica and Fibromyalgia
• Polymyalgia Rheumatica: An inflammatory disease of muscle, likely autoimmune, characterized by severe stiffness and pain in the muscles of the neck, shoulder, and hip areas. People with this condition may also have flu-like symptoms, including fever, weakness, and weight loss.
• Fibromyalgia: Not an inflammatory condition. It is caused by abnormal sensory processing in the central nervous system. People with fibromyalgia may be extremely sensitive to pain and other unpleasant sensation