Beneficial treatment of fibromyalgia
Department of Biosciences, Biomedical Research Centre, Sheffield Hallam University, Faculty of Health and Wellbeing, City Campus, Sheffield, S1 1WB, United Kingdom
Department of Biosciences, Biomedical Research Centre, Sheffield Hallam University, Faculty of Health and Wellbeing, City Campus, Sheffield, S1 1WB
|How to cite this article:|
Lawson K. Beneficial treatment of fibromyalgia.J Postgrad Med 2009;55:159-160
|How to cite this URL:|
Lawson K. Beneficial treatment of fibromyalgia. J Postgrad Med [serial online] 2009 [cited 2020 Jul 10 ];55:159-160
Available from: http://www.jpgmonline.com/text.asp?2009/55/3/159/57386
Fibromyalgia syndrome (FM) is a chronic condition that presents with a complex of symptoms which includes widespread pain, fatigue, dysfunctional sleep and cognitive disruption.  The prevalence of this condition is reported to be 2-4% of the population in developed countries, increasing to greater than 7% of those over 70 years of age. As a consequence this presents as a major financial and social burden to patients with FM and their families and caregivers, and to healthcare systems.
FM has been classified by the American College of Rheumatology (ACR) as a history of widespread pain for at least three months and tenderness, determined by a force of 4 kg, in at least 11 of 18 defined tender points.  The ACR criteria, however, recognize patients presenting with severe pain symptoms, but fail to assess the other symptoms. As a consequence, reliance on ACR criteria fulfillment for diagnosis has been suggested to miss 46% of patients with FM.  Further, FM is often considered to be a rheumatological condition, although evidence supports a neurological basis of the pathophysiology. Therefore use of ACR classification as inclusion criteria can fail to address the diversity of the condition.
Significant progress in the understanding of the pathophysiology and identification of effective treatments of FM has been made recently.  FM is described as a condition of heightened generalized sensitization to sensory input presenting as a complex of symptoms, including pain, where the pathophysiology could include dysfunction of the central nervous system (CNS) pain modulatory systems, dysfunction of the neuroendocrine system, and dysautonomia.  Current management approaches of improving health status in FM use a rehabilitation model, rather than a classic biomedical model, integrating exercise, education (stress management programs, cognitive behavioral therapy (CBT)) and pharmacological treatments.  Although recommendations (e.g. European League Against Rheumatism (EULAR), American Pain Society (APS)) for FM management have been published, , a universally accepted treatment algorithm or approach is often lacking. Although a variety of treatment modalities have demonstrated an improvement in health status in a proportion of patients with FM in clinical trials, these findings require confirmation in usual-care settings of the subjects.
The majority of clinical trials involving investigation of FM have taken place in the USA and Europe and primarily recruited female Caucasian patients. The recent study by Joshi et al.  is an important introduction of the evaluation of patients with FM in a rural setting in a developing country, i.e. India. The impact of FM within developing countries, such as India, is currently unknown and epidemiological studies involving such populations will provide a significant insight to guide decisions regarding the potential of therapeutic approaches. The study by Joshi et al. provides preliminary data regarding a treatment approach to FM, although as identified, there are limitations in the design of the study. Irrespective of the outcome of this preliminary trial, discussion of FM provides the opportunity to raise awareness of the need for further studies to be carried out in the arena of developing countries, in both urban and rural communities.
The chronic nature of FM requires longitudinal investigations to demonstrate the long-term efficacy of therapies. A limitation of such trials, however, is the potential of patient failure of completion. Even with the short duration (12 weeks) of the study by Joshi et al.  a differential was observed in the failure to complete between the drug and physiotherapy groups, where the patient numbers were essentially three times greater in the latter group. Investigation of the potential extrapolation of such findings to a greater patient population is required to assess the full value of the various treatments available.
|1||Lawson K. Treatment options and patient perspectives in the management of fibromyalgia: Future trends. Neuropsych Dis Treat 2008;4:1059-71.|
|2||Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology (1990) criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 1990;33:160-72.|
|3||Katz RS, Wolfe F, Michaud K. Fibromyalgia diagnosis: A comparison of clinical, survey, and American College of Rheumatology criteria. Arthritis Rheum 2006;54:169-76. |
|4||Goldenberg DL, Bradley LA, Arnold LM, Glass J, Clauw D. Understanding fibromyalgia and its related disorders. Prim Care Companion J Clin Psychiatry 2008;10:133-44.|
|5||Burckhardt DC, Goldenberg D, Crofford L, Gerwin R, Jackson K, Kugel P, et al. Guideline for the management of fibromyalgia syndrome pain in adults and children. In APS Clinical Practice Guidelines Series. No 4. Glenview, IL: American Pain Society; 2005.|
|6||Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskila D, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 2008;67:536-41.|
|7||Joshi MN, Joshi R, Jain AP. Effect of amitriptyline vs. physiotherapy in management of fibromyalgia syndrome: What predicts a clinical benefit? J Postgrad Med 2009;55:185-9.|