New Canadian guidelines for treating fibromyalgia

Physicians from the McGill University Health Centre (MUHC) and the University of Calgary have published a review article in the CMAJ (Canadian Medical Association Journal) to help family doctors diagnose and treat fibromyalgia. The article represents the first time researchers have published Canadian guidelines to help manage the condition.

Fibromyalgia is a chronic condition that affects the central nervous system causing pain throughout the body. It is often accompanied by fatigue, depression and sleep problems. It affects mostly women and their multiple symptoms often go years without a proper diagnosis and treatment.

"One million Canadians have fibromyalgia and the time has come to take their suffering seriously. This is a real condition that greatly impacts patients and their families. Finally there are national guidelines to help diagnose and treat this syndrome," says Dr. John Pereira, a study co-author from the University of Calgary's Faculty of Medicine and a physician at the Calgary Chronic Pain Centre.

Fibromyalgia is usually diagnosed by rheumatologists but due to the high prevalence of the disease many patients are not able to seek advice from a specialist. Therefore, primary care physicians are best positioned to take over this role, as recommended by the 2012 Canadian Fibromyalgia Guidelines. In the review, the authors provide evidence-based tools for primary care physicians to make the diagnosis and manage the condition long-term.

"We are the first ones to develop guidelines that look at diagnosis, treatment and follow-up of fibromyalgia," says Dr. Mary-Ann Fitzcharles, corresponding author from the Research Institute of the MUHC and MUHC's rheumatologist. "Currently, there is no cure for fibromyalgia but the guidelines set out the most appropriate management strategy."

Authors recommend non-pharmaceutical interventions such as exercise, relaxation techniques, cognitive behavioral therapy as well as medications tailored to the individual patient. The main treatment goal is to improve quality of life by alleviating the most troublesome symptom(s), with pain recognized as the most common and serious.

Fibromyalgia (FM) was recognized as a true syndrome with the publication of the American College of Rheumatology (ACR) classification criteria in 1990, which were updated in 2010. Taking into account neurophysiologic evidence of pain dysregulation as well as newer treatment options, these guidelines provide direction for optimal patient care and align with best clinical practice. Clinical challenge persists as symptoms are subjective, assessment is dependent entirely on patient report, no objective or laboratory test exists to confirm the diagnosis, and there is an absence of a gold standard of treatment.

With the pivot symptom of pain, the syndrome of FM includes fatigue, nonrestorative sleep, cognitive dysfunction, mood disorder, as well as variable somatic symptoms.