Management for fibromyalgia

Clauw, 2014

Management for fibromyalgia is based on a clear diagnosis supported by a shared understanding between the patient and other members of the treating team. To foster a shared understanding, discussion should include pathophysiology, prognosis and consequences of fibromyalgia within the patient’s unique life circumstances. This approach can prevent excessive investigation and promote development of achievable shared treatment goals.

Other key components of management are thorough patient education informed by pain neuroscience and an individualised management plan. This plan should be developed collaboratively by the patient and their treating clinician(s) with an emphasis on supported self-management. Self-management is fundamental to successful long-term management. A trusted and supportive clinician can help the individual navigate the chronic and variable experience typical of fibromyalgia.

As for other chronic pain conditions, management should be multidimensional incorporating nonpharmacological and pharmacological interventions.

It is helpful to include significant others (eg a partner, relative or friend) in the process of education and self-management, so they support the patient. The patient should be reassured that the condition is not damaging to joints or soft tissues and will not be associated with progressive functional decline. Fibromyalgia can be likened to an alarm system that has become oversensitive and is generating its alarm under conditions that offer no threat to the tissues. It is important to help patients understand that interventions in fibromyalgia aim to muffle the alarm so that it is less intrusive upon other activities; abolishing pain is not usually possible. Some helpful points to discuss with a newly diagnosed patient are set out in Points to discuss with someone newly diagnosed with fibromyalgia below.
Figure 1. Points to discuss with someone newly diagnosed with fibromyalgia.

[NB1]

  • The pain you are experiencing is real but is not caused by tissue damage.
  • Fibromyalgia is not progressive and does not cause permanent damage to your muscles, bones or joints.
  • Fibromyalgia can be frustrating; at times you may feel that you are taking 2 steps forward and 1 step back because your symptoms fluctuate.
  • The chronic pain experienced in fibromyalgia can affect your mood and feelings, but this does not necessarily indicate a problem with your mental health.
  • The goal of management is to enable you to manage your pain (so that it does not limit your ability to function) rather than to achieve a pain-free state.
Note:

NB1: Printed or online information is often useful to reinforce education provided, but should be considered in the context of the recommendations in this guideline.

Some patients may need specialist referral (see When to refer a patient with fibromyalgia to a specialist).

Symptoms due to comorbid rheumatological conditions (eg osteoarthritis, rheumatoid arthritis, inflammatory connective tissue disease) may be difficult to distinguish from fibromyalgia symptoms. Appropriate assessment and management of comorbid conditions that are exacerbating fibromyalgia may help to reduce the impact of the overall disease experience.