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2016 ; 2
(4
): 312-320
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Management of Widespread Pain and Fibromyalgia
#MMPMID28936388
Whibley D
; Dean LE
; Basu N
Curr Treatm Opt Rheumatol
2016[]; 2
(4
): 312-320
PMID28936388
show ga
Specialists' views of fibromyalgia (FM) are typically colored by their
experiences of the selected, complex cases that they are regularly called to
evaluate. At a population level, it is crucial to recognize that education which
promotes patient empowerment and non-pharmacological interventions which support
self-management are very effective. The temptation, for both physician and
patient, to first reach for pharmacological interventions should be resisted
until such holistic approaches are explored. In particular, a strong evidence
base supports graded exercise and cognitive behavioral therapies, but such
treatments must be intelligently "prescribed." As reflected by the recent ACR
criteria, FM is a highly heterogeneous disorder and is not simply a disorder of
pain. For some patients, co-occurring symptoms, such as fatigue, can be equally
as impactful and so management strategies should be sufficiently versatile to
target those dimensions which are considered priorities at the level of the
individual patient. In those patients who do require pharmacological support,
patients should not be led to expect significant gains in isolation. The
importance of self-management requires emphasis at each and every tier of
management. It is true that advances in our understanding of neurobiology have
greatly informed the selection of adjunctive drug classes which may provide
benefit (as well as those which do not-as is the case of opioids). However,
further unpicking of pathogenesis is still required if the FM landscape is to
move further towards drug-led management.