Fibromyalgia Syndrome: The Multimodal Therapeutic Approach Friday, September 11, 2009
by TheHealthMinister | categories Osteopathy | all articles...
massage [1], fibromyalgia [1], fibro-myalgia [1], acupuncture [1]
This complex condition, which I imagine taxes all involved with trying to treat it, has been reviewed with particular reference to a multi-disciplinary approach. This article, published by Medscape, is worth a read. To get the whole text, you will need to join at http://www.medscape.com/medscapetoday.
Fibromyalgia is a chronic, musculoskeletal, non inflammatory pain disorder. Patients frequently suffer from sleep disturbances, headaches, anxiety, morning stiffness, and a poor sense of well-being. It is estimated that approximately 6 million Americans live with this condition. Fibromyalgia is characterized by the presence of at least 11 tender points, as well as widespread bilateral pain for at least 3 months. If left untreated, it may lead to a significant impairment in patients’ quality of life or even disability. Although the exact pathophysiology of fibromyalgia remains a source of speculation, several treatment modalities are available to patients with this condition. Among nonpharmacological options, cognitive-behavioral therapy, patient education, exercise, physical therapy, and diet have all been found effective in reducing the symptoms of fibromyalgia. Pregabalin, a second-generation anticonvulsant, and duloxetine (a selective serotonin and norepinephrine reuptake inhibitor) are the only pharmacological agents approved by the Food and Drug Administration for the treatment of fibromyalgia. However, other medications such as tricyclic antidepressants, selective serotonin reuptake inhibitors, anticonvulsants, and tramadol have been investigated in clinical trials and shown to be effective treatment options. Currently, the recommended management strategy for patients with fibromyalgia is a combination of pharmacological and nonpharmacological treatment modalities
Introduction
Fibromyalgia (FM), also known as fibrositis, is a chronic, noninflammatory, generalized, musculoskeletal pain disorder affecting approximately 6 million patients in the United States.[1,2] FM has historically been a diagnosis of exclusion or something appropriated after ruling out all other possible causes. Patients typically complain of dispersed tender areas as well as sleep disturbance, headaches, paresthesias, morning stiffness, fatigue, anxiety, and impaired quality of life—all very nonspecific symptoms common with myriad other conditions. To date, there is no objective method for ascertaining the etiology of these symptoms. Consequently, many clinicians approach FM with skepticism and shy away from providing effective treatment. Because symptoms often occur in the set-ting of emotional stress, patients with FM may be misdiagnosed with a psychiatric condition. Although FM is the second most common disorder encountered by rheumatologists, only 20% of appropriate candidates receive effective treatment.
Fibromyalgia is predominantly a disorder of women, seen mostly between the ages of 20 and 50 years.[2] Because of a tendency to run in families, genetic factors are believed to be involved in its pathogenesis. Epidemiological data link FM with female sex, lower socio-economic status, lack of college education, and a history of divorce. Moreover, anxiety, depression, and headaches are the most common comorbid diagnoses among patients with fibromyalgia.[1,2] Many of these patients also suffer from irritable bowel syndrome (IBS), an idiopathic gastrointestinal disorder that, not unlike FM, is exacerbated by physical and emotional stressors.
Fibromyalgia was first recognized by the American Medical Association (AMA) as a “true” illness and a cause of disability in 1987.[4] The first diagnostic criteria for FM were developed in 1990 by the American College of Rheumatology (ACR).[4] According to the ACR diagnostic guideline for fibromyalgia, patients experience widespread pain on each side of the body, below as well as above the waist, for at least 3 months. In addition, the criteria stipulate that patients have 11 tender points out of the maximum 18 specified sites identified by the physician via a palpating technique. In effect, the ACR criteria established FM as an independent disorder with distinct diagnostic characteristics.[3] The sensitivity and specificity associated with the ACR criteria for FM are 85%.[3]
The creation of the ACR diagnostic criteria has made considerable headway toward identification of FM patients who would otherwise be overlooked or misdiagnosed. However, it is still important to be aware of similar conditions with masking presentations. The differential diagnosis includes the following: hypothyroidism, autoimmune and rheumatic disorders, multiple sclerosis, myofascial pain syndrome, chronic fatigue syndrome, and systemic lupus erythematosus.[1,2] Consequently, appropriate laboratory studies should be performed to exclude the possibility of these conditions. Once a patient is diagnosed with fibromyalgia and other causes have been ruled out, appropriate management should commence. Optimal management consists of a multidisciplinary approach integrating pharmacological as well as nonpharmacological therapies (ie, cognitive-behavioral therapy, exercise, patient education).[1–3]
prev New Review Endorses CV Benefits of Fish Oil ... next 3D Animation of CSp and Disc Anatomy
Comments
There are no comments on this article... why not make your mark?
Social site bookmarking