APS Press Room
| For immediate release October 10, 2005 |
Contact: Chuck Weber (847) 705-1802 |
AMERICAN PAIN SOCIETY RELEASES NEW CLINICAL PRACTICE GUIDELINE FOR FIBROMYALGIA PAIN
GLENVIEW, Ill., Oct. 10, 2005 – Fibromyalgia syndrome (FMS) has no cure, is difficult to diagnose, and effective pain management strategies are a must to help patients cope with the disease. Today, the American Pain Society announced publication of the first-ever clinical practice guideline designed to help clinicians relieve pain and improve overall quality of life for adults and children with FMS.
It is estimated some 12 million Americans have FMS, characterized by widespread muscle and joint pain and myriad other symptoms. FMS is far more prevalent in women and the incidence increases with age, reaching 7 percent among women 65 years and older.
“FMS is diagnosed mainly in primary care settings, so it’s imperative that internists, family practitioners and physician assistants be knowledgeable about assessment, basic treatment and ways to provide continuing care to FMS patients,” said APS President Dennis C. Turk. He added that treatment of FMS begins with confirming the diagnosis and explaining the current understanding of the disorder.
Although widespread, persistent pain is the dominant FMS characteristic, other related symptoms – fatigue, headache, poor sleep, psychological distress and cognitive dysfunction often are part of the syndrome. “People with FMS experience work stresses, have less time for social, family and leisure activities, find it difficult to perform physical tasks and endure an impaired quality of life,” said Don L. Goldenberg, MD, co-chair of the FMS Pain Management Guideline Panel, chief of rheumatology at Newton-Wellsey Hospital (Mass.) and professor of medicine, Tufts University School of Medicine.
“Because the impact of FMS can be so pervasive, management of the syndrome should be holistic and multidisciplinary and employ both pharmacologic and non-pharmacologic strategies,” said panel co-chair Carol S. Burckhardt, PhD, RN, professor of psychiatric and mental health nursing, Oregon Health and Science University. “It is critical for those diagnosed with FMS to develop skills for managing their symptoms on a daily basis, and the guideline emphasizes that treatment for adults and children should focus on restoring physical and emotional function.”
Diagnosis and Assessment
The APS guideline recommends that clinicians perform a complete joint examination, manual muscle strength testing and a neurological exam. A clinical diagnosis of FMS should be based on the presence of widespread pain (all four quadrants of the body and along the midline axial) for at least three consecutive months and decreased pain tolerance when pressing on nine of 18 sites on the body. Further, evaluating the severity of related symptoms, such as fatigue, sleep disturbances and mood disorders, will help measure the impact of the syndrome on physical and emotional function and overall health-related quality of life.
Pharmacologic Therapies
Antidepressants are recommended as first-line treatment for FMS because they affect multiple symptoms – pain, fatigue, depressed mood and sleep disturbances. According to the guideline, tricyclic antidepressants and newer selective serotonin reuptake inhibitor (SSRI) medications, as well as dual reuptake inhibitors, can provide effective symptom relief but not complete elimination of pain. It further reports that NSAIDS, including COX-2 drugs, have not been found to be effective for treating FMS pain, and potent opioid pain medications, such as morphine and oxycodone, should be considered only if all other pharmacologic and non-pharmacologic options have been exhausted.
Non-pharmacologic Therapies
These treatments consist of cognitive-behavior therapy that includes attention to perceptions of self control and education. Self management strategies are recommended whereby people with FMS assume the major responsibility for activities that help them cope with symptoms and the impact of the syndrome on all aspects of functioning.
Moderately intense aerobic exercise at least two or three times a week was strongly encouraged by the APS guideline panel. Exercise progression, however, should start at low levels and increase at a slow and gradual pace to avoid exercise-induced pain exacerbation and possible discontinuation of the workout program. Clinician-assisted treatments, such as hypnosis, acupuncture, therapeutic message and chiropractic manipulation, may be useful for adjunctive pain relief. If treatment for depression is required, psychiatric consultation is recommended.
For Children and Adolescents
The APS guideline recommends that treatment for children and adolescents should focus on maximizing function and stressing the importance of regular school attendance. Clinicians, therefore, are advised to work with the child and family on an ongoing basis to increase self-care skills, improve self-efficacy, and enhance understanding of the interrelationships between pain and mood, stress and family environment. In addition to the pharmacologic treatments recommended for FMS pain, the guideline emphasizes the benefits for children with FMS of aerobic exercise for minimizing pain, improving sleep quality, enhancing self-efficacy, and increasing positive mood.
The FMS publication is the fourth pain management clinical practice guideline developed by APS. It follows publication of The Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease in 1999, The Guideline for the Management of Osteoarthritis, Rheumatoid Arthritis and Juvenile Chronic Arthritis in 2002 and The Guideline for the Management of Cancer Pain in 2005.