Fibromyalgia has only recently become well known and accepted by the medical community. For this reason, and the fact that there is little known about the illness, many people with FM go many years without a diagnosis. This, alongside historical lack of recognition of the condition, including many patients reporting they have been told “it’s all in your head”, may result in some patients having negative attitudes towards health professions. Consequently, affirmation and acknowledgement of patient experiences and pain is vitally important in treating people with FM. For some patients, there may also be significant rapport building required to establish an open and trusting relationship.

GENERAL TIPS

  • Book longer appointments for your FM patients, particularly early on
  • Invest significantly in rapport building and empathising
  • Affirm patient’s pain experiences as real and valid
  • Remember that distrust towards the medical profession is likely rooted in valid reasons, but that these do not necessarily reflect on you
  • Don’t be disheartened by patients’ lack of improvement- it usually takes a lot of trial and error to get management right
  • Many FM patients have in-depth knowledge of their illness. This can be a result of interest; perceived lack of understanding from the medical profession; experience with multiple treatments and practitioners; and observation of their own symptoms, often over a long period of time. Try to engage the patient further rather than assuming this is an indictment on your opinion or management.
  • Pay extra attention to clear communication- especially for patients who suffer from severe brain fog. Check understanding, and write down notes if necessary.
  • Take patient concerns seriously- some seemingly minor symptoms (such as pain from clothing or blankets on skin) can cause major distress and debilitation.
  • Keep an open mind to alternative and allied therapies. Many FM patients seek alternative therapies for a range of reasons, and emerging medical evidence suggests some may provide significant benefit. Remember that patients will often have an important and close relationship with other providers, so be tactful when making recommendations.

PHARMACOTHERAPY

Pharmacotherapy alone is not effective for the treatment of Fibromyalgia, and should be used in conjunction with exercise, nutrition, stress reduction, improvement of sleep hygiene, and CBT.

Pain medications such as Paracetamol and NSAIDs are not effective in the management of Fibromyalgia. Tramadol may be effective for some short-term pain management, but long term opioid use is not recommended by the FDA.

Drugs targeting serotonin and noradrenaline, such as duloxetine and milnacipran have been found to be helpful in controlling FM pain levels. Older drugs such as amitriptyline and cyclobenzaprine may also be used.

Pregabalin (Lyrica) is also approved by the FDA, and has recently been funded in New Zealand. Pregabalin and gabapentin inhibit overactivity of some neurons involved in pain transmission.

In all cases, it’s important to carefully monitor side effects, as patients with FM may be particularly sensitive to changes.

Source: American College of Rheumatology

RESEARCH & RESOURCES

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