Fibromyalgia
4.2. Individualized, Symptom-Focused, Multidisciplinary Treatment Treatment outcome may be maximized in an individual patient by
Table 2 Individualized, Symptom-Focused Fibromyalgia Treatment Troublesome symptomTherapistTreatment Body painPhysicianAntidepressant; Gabapentin; Tizanidine Physical therapistAerobic exercise/reconditioning; Stretching exercises Occupational therapistWork station modification; Body mechanics PsychologistStress management; Cognitive–behavioral therapy; Relaxation training FatiguePhysical therapistAerobic exercise Occupational therapistPacing skills NursingNutritional counseling Irritable bowel syndromePhysicianLaxatives; Anti-diarrhea agents; Antidepressants Physical therapistAerobic exercise PsychologistStress management NursingDietary counseling: high-fiber, good hydration, low-fat, frequent small meals Sleep disturbancePhysicianAntidepressants PsychologistRelaxation training NursingSleep hygiene Depression/anxietyPhysicianAntidepressants PsychologistCounseling; Psychotherapy HeadachePhysicianAntidepressants or other standard headache therapy PsychologistStress management; Biofeedback Note: Choose possible treatments based on the presence of troublesome symptoms.
Table 1 Online Psychiatric Screening Tools Website addressSymptom tested http://www.healthyplace.com/site/tests/psychological.aspSeparate tests screen for depression, anxiety, personality traits, and stress http://www.psychcorp.comStandard depression assessment tool: Beck Depression Inventory http://www.mindgarden.com/Assessments/Info/staiinfo.htmStandard anxiety assessment: State-Trait Anxiety Inventory
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5. SUMMARY
Fibromyalgia is a common, chronic pain condition affecting approximately 3% of women and 0.5% of men. Patients with fibromyalgia report a wide vari-ety of troublesome somatic complaints, including fatigue, sleep disturbance, pares-thesias, headache, and digestive complaints. Fibromyalgia is diagnosed by the presence of widespread body pain and at least 11 of 18 possible tender points that are painful to digital palpation. Recording and monitoring the ten-der point examination aids both in the establishment of a diagnosis and assess-ment of treatassess-ment efficacy.
Symptoms of fibromyalgia are not progressive and tend to improve over time. Symptom improvement can be maximized by identifying, targeting, and treating troublesome symptoms in each individual patient. Antidepressants are the most beneficial types of medication for individuals with fibromyalgia, as they help reduce pain, depression, and headache and help improve sleep. Aero-bic exercise and learning proper activity pacing skills, body mechanics, and sleep hygiene techniques are also beneficial.
REFERENCES
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Box 6
Online Fibromyalgia Resources
• National Fibromyalgia Association web page fmaware.org
• Arthritis Foundation
arthritis.org/conditions/diseasecenter/fibromyalgia/fibromyalgia.asp
• National Fibromyalgia Partnership, Inc.
fmpartnership.org
• John Hopkins Arthritis web page
www.hopkins-arthritis.som.jhmi.edu/other/fibromyalgia.html
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March 14–17, 2002; Baltimore, MD: 21st Annual Scientific Meeting of the American Pain Society.
b. Fibromyalgia prevalence increases with advancing age.
c. Fibromyalgia is associated with better quality of life and less disability than other types of widespread pain or rheumatologic disease.
d. A and B e. All of the above
3. Typical associated symptoms with fibromyalgia include:
a. Fatigue
b. Irritable bowel syndrome c. Bleeding disorder d. A and B
e. All of the above
4. The class of medications that is most effective for treating fibromyalgia symptoms con-sists of:
a. Opioids b. Antidepressants c. Analgesics d. Muscle relaxants