Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-25T19:37:29.651Z Has data issue: false hasContentIssue false

The Role of Non-Pharmacologic Approaches in the Management of Fibromyalgia

Published online by Cambridge University Press:  07 November 2014

Extract

The optimal management of fibromyalgia (FM) is comprised of both pharmacologic and nonpharmacologic approaches. This multidimensional approach is preferred given that FM is not only a pain condition, but involves a number of other symptoms as is reflected in the new clinical criteria being developed by Wolfe and colleagues. Proper management of FM should be informed through multidimensional assessment of the clinically relevant domains described previously in this supplement. Pharmacologic and nonpharmacologic approaches work together to provide the broadest possible coverage of these domains, minimize the impact of each domain on functioning and well-being, and facilitate long-term adaptations to one's lifestyle.

The use of nonpharmacologic strategies in the management of FM has varying levels of evidence. The strongest evidence currently exists for aerobic exercise, cognitive-behavioral therapy (CBT), and for patient education or self-management. Moderate evidence exists for strength training, acupuncture, hypnotherapy, and biofeedback modalities. Weaker evidence exists for manual massage therapy. Currently, there is no evidence of long-term benefit for tender point injections or flexibility exercise modalities, although these options may be beneficial in the short term. This article will focus on the three areas that have the strongest evidence base: patient education, exercise, and CBT.

Educational programs are typically offered in the context of primary care or in specialty practices. In their simplest form, these programs try to dispel myths about FM and provide patients with the most up-to-date knowledge about the condition.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Wolfe, F, Clauw, DJ, Fitzcharles, MA, et al.Clinical Diagnostic and Severity Criteria for Fibromyalgia. Paper presented at: the 73rd Annual Scientific Meeting of the College of Rheumatology/Association of Rheumatology Health Professionals; October 18, 2009; Philadelphia, PA.Google Scholar
2.Goldenberg, DL, Burckhardt, C, Crofford, L. Management of fibromyalgia syndrome. JAMA. 2004;292(19):23882395.CrossRefGoogle ScholarPubMed
3.Williams, DA, Cary, MA, Groner, KH, et al.Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention. J Rheumatol. 2002;29(6):12801286.Google ScholarPubMed
4.Karper, WB, Jannes, CR, Hampton, JL. Fibromyalgia syndrome: the beneficial effects of exercise. Rehabil Nurs. 2006;31(5):193198.CrossRefGoogle ScholarPubMed
5.Busch, A, Schachter, CL, Peloso, PM, Bombardier, C. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2002;(3):CD003786.Google ScholarPubMed
6.Mease, P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol Suppl. 2005;75:621.Google ScholarPubMed
7.Staud, R. Are tender point injections beneficial: the role of tonic nociception in fibromyalgia. Curr Pharm Des. 2006;12(1):2327.CrossRefGoogle ScholarPubMed
8.van Koulil, S, Effting, M, Kraaimaat, FW, et al.Cognitive-behavioural therapies and exercise programmes for patients with fibromyalgia: state of the art and future directions. Ann Rheum Dis. 2007;66(5):571581.CrossRefGoogle ScholarPubMed
9.Williams, DA. Cognitive and behavioral approaches to chronic pain. In: Wallace, DJ, Clauw, DJ, eds. Fibromyalgia and Other Central Pain Syndromes. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.Google Scholar
10.Thieme, K, Turk, DC, Flor, H. Responder criteria for operant and cognitive-behavioral treatment of fibromyalgia syndrome. Arthritis Rheum. 2007;57(5):830836.CrossRefGoogle ScholarPubMed
11. FibroGuide. Available at: www.knowfibro.com/fibroguide.jsp. Accessed November 24, 2009.Google Scholar