Fibromyalgia benefits from comprehensive approach to care

A clinical review in JAMA on the controversial topic of fibromyalgia syndrome has recommended a stepwise approach to therapy based on education, medication, exercise and cognitive therapy."We believe that establishing the diagnosis, if integrated with education, is an essential component of high-quality of management," the review stated. Concerns that being 'labelled' with fibromyalgia might worsen outcomes had not been confirmed by research on the issue.Many different medications had been trialled, but the strongest evidence was for low-dose tricyclic antidepressants. There was less convincing evidence for other drugs such as SSRI antidepressants and tramadol. Aerobic exercise and muscle strengthening were known to be effective, improving tender-point pain threshold, pain and aerobic performance. Psychological and behavioural therapies, especially cognitive behavioural therapy, were able to reduce pain and improve function. All these approaches could be combined by a multidisciplinary team to ensure comprehensive evidence-based treatment.There were no randomised controlled trials of trigger-point and tender-point injections, but some evidence suggesting modest benefit from other therapies including relaxation techniques, biofeedback, hypnosis, acupuncture, spinal manipulation and soft-tissue massage.Patients with fibromyalgia syndrome had lowered mechanical and thermal pain thresholds, an exaggerated response to noxious stimuli and altered temporal summation of pain stimuli. Research during the past decade had demonstrated similar abnormalities in pain processing in other chronic conditions such as chronic fatigue syndrome, irritable bowel syndrome and chronic muscular headaches. These syndromes were all defined by subjective symptoms and a lack of unique pathophysiological characteristics.About 3.4% of women and 0.5% of men in the United States were estimated to have fibromyalgia. Diagnostic criteria of the American College of Rheumatology had about 85% sensitivity and specificity in differentiating it from other forms of chronic musculoskeletal pain.Reference...