Top tips on fibromyalgia

Fibromyalgia syndrome (FMS) is a common chronic musculoskeletal pain syndrome. Reported prevalence rates vary depending on the classification criteria used; in the UK the prevalence is estimated to be 5.4%, with women more commonly affected than men.

1.What are the symptoms of Fibromyalgia?

Typically, patients have widespread pain for more than three months which is often accompanied by fatigue, sleeplessness and cognitive symptoms.

People with FMS also commonly report an array of associated somatic symptoms e.g. irritable bowel syndrome, headache, pain/cramps in the abdomen, numbness/tingling, dizziness etc.

The extent of somatic symptoms is factored in to the classification criteria. Mood disturbance such as depression, distress and anxiety are also often a feature of FMS.

2. Do you have any diagnostic/assessment techniques?

Diagnosis of FMS is by clinical assessment and there is some evidence that patients benefit from receiving a diagnosis.

The American College of Rheumatology 2010 classification criteria state that a patient can be classified with FMS if they satisfy the points below:

  1. Widespread pain index (WPI) ≥7 and symptom severity (SS) scale score ≥5 or WPI 3–6 and SS scale score ≥9.
  2. Symptoms have been present at a similar level for at least three months.
  3. The patient does not have a disorder that would otherwise explain the pain.

The SS scale score is the sum of the severity of the three symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. The final score is between 0 and 12 (Wolfe et al 2010).

Note that tender point count no longer forms part of the diagnostic criteria for FMS.

There are a number of conditions that can mimic FMS and of course it is essential that these conditions are excluded. Rheumatological conditions that should be factored in to the differential diagnosis include: mild systemic lupus erythematosus, polyarticular osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica, hypermobility syndromes, inflammatory muscle disease, hypercalcaemia and osteomalacia. Non-rheumatological diseases that can mimic FMS include: thyroid dysfunction, neoplastic disease and neurological diseases such as multiple sclerosis.

3. Do you have any self-management advice for patients?

The foundation of FMS management is non-pharmacological interventions, education and physical activity. Where appropriate, psychological therapies such as cognitive behavioural therapy or acceptance and commitment therapy have a role in the management of FMS.

While exercise and physical activity interventions are recommended, many patients find exercise interventions extremely challenging. Patients will benefit from advice and education prior to embarking on any physical activity intervention.

An understanding of the nature of chronic pain, delivered within a biopsychosocial context is essential for patients with FMS. Advice about activity pacing is useful and can help patients avoid the ‘boom and bust’ cycle so commonly seen in FMS. There is some evidence that patients with FMS are more satisfied with their treatment where their health care provider has a good understanding of the condition.