Chronic widespread pain, including fibromyalgia: a pathway for care developed by the British Pain Society

Abstract

Chronic widespread pain (CWP), including fibromyalgia, is a highly prevalent condition with a range of disabling symptoms, both physical and psychological. The British Pain Society (BPS) is supporting the treatment of this group of patients through a care pathway and this article describes the rationale and discussion points relevant to the CWP and fibromyalgia pathway. There are several aims in producing this pathway: to reduce variation in the standards of care, to reduce delays at all stages of care, and in particular, to enable clinicians to help patients accept a diagnosis of CWP. This diagnosis should be based on the presence and distribution of symptoms in the absence of another defined pathological process: the features in the history or clinical examination are generally more important than laboratory investigations. There is an emphasis on addressing all aspects of symptomatology (physical, psychological, social, and personal needs) without an overemphasis on any one treatment modality. The pathway has focused on the potential pitfalls in the use of long-term opioids and the rationale is provided why these are not recommended. Patients with CWP value explanation and education and although clinicians may be unfamiliar with the condition, the majority of clinicians have generic skills in managing long-term conditions which can be supplemented by the interventions and actions detailed in this pathway.

National survey of pain clinics in Croatia: Organization and services

“…There are several international manuscripts about the organization and delivery of pain services that could be used as a guidance for improving pain management (28)(29)(30)(31)(32). Educational activities in most pain clinics in Croatia focus on providing educational materials for patients developed by pharmaceutical companies, and less frequently on educational materials developed by the Croatian Association for the Treatment of Pain or employees of the clinics.…”

Identifying patients with chronic widespread pain in primary care: Erratum.

“…Treatment focused on regional pain syndromes alone may be suboptimal if the added burden of pain elsewhere in the body-and the additional characteristics associated with it (such as pain severity and propensity for long-term persistence)-is not identified and taken into account in explanation, advice, and care given to the patient. 4,25 There is some underrecognition of CWP in primary care, implying a need for specific training for GPs. If some patients are not recognized as having generalized pain conditions with associated somatic symptoms, they may be inappropriately managed (as multiple episodes of regional pain).…”

Physical Activity to Reduce Systemic Inflammation Associated With Chronic Pain and Obesity

“…The cost to national economies in terms of lost work days, benefit claims and healthcare is estimated to be billions of pounds [17].…”