There is abundant and overwhelming data to support the concept that fibromyalgia is a real clinical disorder. What's more there is valid biology and neurobiology that supports the reasons why patients with FM have the pain they complain of.



Recent positron imaging and magnetic resonance imaging studies have demonstrated reproducible and validated abnormal brain functioning in patients with FM.

Finally, it is recognized by experts in the field that FM is separate from other functional illnesses that are usually considered psychiatric illnesses.

That being said, it is important that a multidisciplinary approach to the disorder be used. While rheumatologists are the specialists who most often see patients with FM, non rheumatologists, including psychiatrists, physiatrists, physical therapists, occupational therapists, and chiropractors should be involved.

Fibromyalgia is a chronic medical illness that needs to be looked at from the viewpoint of multiple contributing factors including behavioral, psychological, social, and environmental situations.

All of these issues are important in both determining the clinical course as well as treatment outcomes. Most FM patients have co-morbid conditions and symptoms that need to be addressed, especially mood disorders and, in even greater numbers, sleep disorders.

The diagnosis of FM is fairly straightforward. However, it still remains a diagnosis of exclusion meaning appropriate laboratory tests and other diagnostic studies to exclude "mimics."

The condition is first suspected by the patient's symptoms of widespread pain accompanied by sleep disturbance, chronic fatigue, mood changes, irritable bowel symptoms, headaches, and short term memory difficulties. The physical examination should reveal no significant organic abnormalities.

The treatment of fibromyalgia revolves around three main modalities. These are patient education, cognitive behavioral therapy, relaxation techniques, injections, physical therapy, non-impact aerobic exercise, and medications.

Pharmacologic treatment includes the use of tricyclic antidepressants, muscle relaxants, serotonin reuptake inhibitors, dual reuptake inhibitors (drugs that reduce uptake of both serotonin as well as nor-epinephrine, and anti-seizure medications. Occasionally, short acting amphetamines can be useful for the fatigue component of FM.

Opioids are generally not indicated. However, non opioid pain relievers such as tramadol can be useful.

Of the anti-seizure medicines, gabapentin (Neurontin) and pregabalin (Lyrica) have been the most studied.

The dual uptake inhibiting drugs milnacipran and duloxetine (Cymbalta) have been shown to reduce pain transmission in FM through the increase in neurotransmitter levels of both serotonin and nor-epinephrine and are valuable.

Long term disability, while often sought for can be detrimental if the patient becomes inactive and isolated. Every attempt should be made to keep the patient as active and as involved as possible.

There are times though when disability is best for the patient and therapy needs to be individualized.

The bottom line is that FM is real, common, and must be addressed by physicians who are willing to be empathetic and knowledgeable.