Fibromyalgia: management strategies for primary care providers

Abstract

SummaryAimsFibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management.MethodsWe reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements.ResultsThe implementation of a framework for chronic pain management in primary care would limit unnecessary, time‐consuming, and costly tests, reduce diagnostic delay and improve patient outcomes.DiscussionThe patient‐centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training.ConclusionAlthough there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting.

A pilot study of health and wellness coaching for fibromyalgia

“…The protocol had two components, biweekly private telephone sessions and 18 group telephone sessions over the 12 month period. All study participants [9] participated in the group sessions. The number of private sessions was determined by the the client, not the coach.…”

“…Current treatment options include variable combinations of pharmacological and nonpharmacological treatments such as exercise and cognitive behavioral therapy (CBT) [9]. The European League Against Rheumatism (EULAR) has issued strong recommendations for the use of tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors, serotonin reuptake inhibitors, gamma-amino butyric acid analogues like gabapentin and pregabalin, and only weak recommendations for non-pharmacological therapies such as aerobic exercise, CBT and combination therapy [10].…”

Are articles labelled as “Editor's Choice” downloaded more?

“…As a bibliometric experiment, I made a list of all EC articles from 2016 to 2017, excluding editorials, and examined the number of downloads from the journal's website ascertained by Wiley as of 22 August 2018 (Table ). For the articles published in 2016 and 2017, I also compiled a list of the top 10 downloaded articles from the journal (Table ). How many of my EC articles made the top 10 list?…”

“…The list of the top downloads contained in Table includes five articles previously flagged as an EC in Table . Number 7 on the top 10 list, “What to watch in medicine in 2017: Hot topics” was an editorial, and although designated as EC, was excluded from Table .…”

Impaired diffuse noxious inhibitory controls in specific alternation of rhythm in temperature-stressed rats

“…Although the American College of Rheumatology has published the 2010 Preliminary Diagnostic Criteria for fibromyalgia (Wolfe et al, 2010), it is not widely used in clinical practice (Arnold et al, 2016). Although the etiology of fibromyalgia remains unknown, it is widely believed that physical and mental stressors, accidents, and surgery may lead to fibromyalgia (Bradley, 2009;Theoharides et al, 2015).…”