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Saturday, May 18, 2013

New Guidelines for Fibromyalgia treatment and diagnosis released 2013

New Guidelines for Fibromyalgia treatment and diagnosis released 2013

I go more into the change from specialist care to phsycian care. Some of the difference between our guidelines and the US as to the features of FM and discuss the treatment a little.

Anyway, personally...
I love that they are setting specific guidelines for physicians to treat FM. About freaking time. My treatment has been nill to indifferent when it comes to doctors. I saw a specialist one time... when I was diagnosed. I was put on Lyrica... by my neurologist as a off label migraine preventative that also might help with FM so in fact my neuro did more to treat my FM than anyone else since my diagnosis. Doctors sometimes help with symptoms that get bad if they can, most often not. One doctor put me on a sleeping pill... because of the migraines going nuts in the morning because my sleep was so poor due to the FM, not because of the sleep dysfunction from the FM which is rarely in-itself treated. Which I know because I had been told so many times... chronic insomnia cannot be treated. I do believe way back in the day one doctor tried one medication known at the time to be used off label for FM but it didn't work and the side effects were... brainlessly not fun. So yeah some actually help on that side would be nice. I just don't like the idea of doctors diagnosing people with FM because I have seen how that can go array. With the old criteria in the States doctors were not even following the criteria so how can we expect them to take the time to properly diagnose someone with FM? They don't take the time to treat them right now. I think it is easier for them to order the tests to rule out other conditions and then send the patient to a specialist to diagnose. I figure it is just because rheumatologists don't want to see these patients as it is not in this category any more but neither do neurologists. So we get left to the wayside. Just my opinion. And when they get the diagnosis, well, then it is luck of the draw whether that patient has a good doctor, a mediocre one or an indifferent one as to whether they will get any treatment for it.

However and this is a big however... the guidelines are pretty good and they are trying to put an emphasis on physician care. On their role with the patient and what can be done with FM. And this I think can reduce stigma and promote better care for FM patients. I found a great doctor, who happens to be relocating so maybe I'll never see this, or maybe I will. Maybe new patients will. I do know the lack of treatment I received due to lack of knowledge is not the way to go and future people diagnosed deserve better care than that. And the same goes to those that received Over treatment which is also common, too many medications, which leads to overlapping side effects and worse quality of life. More knowledge on how to treat patients will benefit everyone who is diagnosed.

Here is a little I could not fit into the article... some details from the guidelines:

Canadian Guidelines  worth the read through really. Interesting.

Features of FM:

Pain: Pain is the primary complaint in persons with FM and should have been present for at least 3 months. Pain onset is usually insidious, sometimes beginning in a localized area, may initially be intermittent, and then progressively becomes more persistent. Although pain is felt in muscle or joint areas, there is no physical abnormality of these tissues. A neuropathic mechanism to the pain may be suggested by report of a burning quality to the pain [14, 15]. Pain may vary in location and intensity from day to day, and can be modulated by factors such as weather or stress [16]. Cold and humid weather tends to be associated with increased symptoms [16, 17].

Fatigue: Fatigue, reported to be present in over 90% of FM patients, is the most common associated complaint [3]. Fatigue may even be more disabling than pain for some, and contributes to subjective report of functional impairment.

Nonrestorative sleep: Nonrestorative sleep is associated with FM [20]. Abnormal components of sleep that have been measured include sleep latency, sleep disturbance, and fragmented sleep leading to impaired daytime function [21, 22]. Poor sleep negatively impacts fatigue, affect, and pain, with improvement in these parameters when sleep specifically is addressed [23-26]. Other sleep disorders such as restless leg syndrome or sleep apnoea may also occur in patients with FM

Cogntive dysfunction: Cognitive dysfunction which includes poor working memory, spatial memory alterations, free recall, and verbal fluency associates with pain in FM as well as other pain patients and is different from healthy controls

Mood disorders: Mood disorder, including depression and/or anxiety, is present in up to three quarters of persons with FM, but mood disorders and FM are likely distinct [31].

Pain related somatic symptoms: Somatic symptoms, including irritable bowel syndrome, migraine headaches, severe menstrual pain, lower urinary tract symptoms, myofascial facial pain, and temporomandibular pain have all been associated with FM [36-39].


Although the cause of FM is unknown, understanding that neurophysiological changes present in FM will reassure healthcare professionals that this condition is valid. An elementary appreciation but not in-depth knowledge of neurophysiological mechanisms will also help towards treatment choices. Neurophysiologic testing remains in the research domain and is not currently available for routine patient care, nor should be required to confirm a diagnosis of FM.

Abnormalities in pain processing have been identified at various levels in the peripheral, central, and sympathetic nervous systems, as well as the hypothalamo-pituitary-adrenal (HPA) axis stress-response system. Documented abnormalities include evidence of peripheral sensitization and wind-up phenomenon, central sensitization with changes in functional MRI and SPECT scans of the brain, increased levels of substance P in the cerebrospinal fluid, and impairment of descending noxious inhibitory control (DNIC)
Familial studies point to some genetic predisposition with up to 26% of relatives of patients with FM reporting chronic widespread pain (CWP), and FM diagnosed in 28% of offspring of FM women [119, 120]. Genetic factors may predispose some individuals to a dysfunctional stress response via the HPA axis [121]. While no individual gene has been associated with FM, there is increasing evidence of a polygenic effect, with polymorphism of genes affecting serotoninergic, catecholaminergic and dopaminergic systems playing a role [122, 123].

Psychosocial distress has been shown to predict onset of chronic widespread pain in population studies conducted in England [124, 125]. Early life adversity is linked to chronic widespread pain in adult life [126]. Abuse, which may have been sexual, physical or psychological, particularly in childhood has been reported with greater frequency in FM patients than controls [127-129]. These numerous interacting factors may be the

setting in which a stressful event, which could be physical such as a viral illness, traumatic, or psychological, can lead to a vulnerable health status and may be a trigger for FM as reported for nearly a quarter to a third of persons with FM [130].
11. Healthcare professionals should be knowledgeable that objective neurophysiologic abnormalities have been identified in patients with fibromyalgia in the research setting, but are not available in clinical practice for either the diagnosis or care of persons with fibromyalgia [Level 5 [111, 117], Grade D].
12. Patients and healthcare professionals should acknowledge that genetic factors as well as previous adverse events may have contributed to the development of fibromyalgia, but focusing excessively on a triggering event could compromise patient care and should therefore be discouraged [Level 5 [123, 126, 130], Grade D].

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