31st January 2024

Fibromyalgia

Optimal management consists of prompt diagnosis and patient information, including written information. There should be a comprehensive assessment of pain, functional status, and psychosocial well-being. A multidisciplinary approach with GPs, rheumatologists, physiotherapists, and psychologists should be used. The management is graduated, starting with exercise programmes and physiotherapy, slowly increasing the intensity of exercise. Additional therapies such as hydrotherapy or acupuncture can be helpful. Patients should be encouraged to continue working if able. Response should be reassessed, and if there is insufficient effect, additional individualised management instituted. These include psychological therapies, usually cognitive behavioural therapy for pain-related depression, anxiety or poor coping mechanisms. Pharmacotherapy can be used for severe pain or sleep disturbance. The common medications used include duloxetine, pregabalin and tramadol for severe pain. Low-dose amitriptyline, cyclobenzaprine or pregabalin at night are often used for severe sleep issues. Multimodal rehabilitation programs can be used for severe disability.