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New Canadian guidelines for fibromyalgia reviewed

Most patients with fibromyalgia can be diagnosed and treated by primary care physicians, according to a recent study review of new Canadian guidelines on the syndrome.

“In the past few years, there has been a surge in novel research in [fibromyalgia] and even new criteria proposed to diagnose it,” review author John X. Pereira, MD, of the University of Calgary’s Faculty of Medicine, told Healio.com. “Clinical guidelines with clear treatment recommendations were long overdue.”

 

John X. Pereira

The 2012 Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome were developed through a literature search. Eighteen key questions, based on input from 139 health care professionals, were used in the search, which produced 150 suitable articles. Sixty recommendations were drafted, and 35 health care professionals accepted 46 recommendations in the final guidelines.

Key points include:

• Fibromyalgia is “a clinical construct” with no confirmatory clinical or laboratory test to confirm it.
• The chief symptom is pain, which is associated with sleep disturbance, fatigue, cognitive changes and variable severity of mood disorder.
• A multimodal strategy, combining nonpharmacologic and pharmacologic treatments, is the “ideal management” approach, with the understanding that symptoms fluctuate over time.
• Fibromyalgia can be diagnosed by a primary care physician without a specialist’s confirmation, “and the current practice of extensive investigations should be curtailed.”

“The majority of patients with fibromyalgia are best diagnosed and treated by their family physician,” Pereira said. “Everything we recommend in the guidelines can be done and coordinated by primary care health providers for most patients. Fibromyalgia is a lifelong condition and a strong relationship with your family doctor is key.”

The guidelines review highlighted how to diagnose and treat fibromyalgia.

 

Mary-Ann Fitzcharles

“The diagnosis is purely clinical and reliant upon a composite history and physical examination, without abnormality in any laboratory test,” review author Mary-Ann Fitzcharles, MB, ChB, of the Research Institute at McGill University Health Centre, told Healio.com. “Treatments should be focused toward symptom relief and tailored to the individual patient, with emphasis on nonpharmacologic measures that promote internal locus of control.

“What might surprise clinicians is that we have strongly advocated to eliminate the tender point count as a diagnostic tool. This finding has been used, misused and abused in the past as it is dependent upon subjective report without any solid physiologic foundation and focuses only on pain rather than the global concept of [fibromyalgia].”

Disclosure: See the study for a full list of relevant disclosures.