Unravelling Fibromyalgia – Steps Towards Individualized Management

5 years ago

Unravelling Fibromyalgia – Steps Towards Individualized Management

The heterogeneity of the clinical presentation and the pathophysiologic mechanisms associated with fibromyalgia (FM), and the modest results on average for any therapy, call for a more individualized management strategy. Individualized treatment can be based on subgrouping of patients according to associated conditions (mental health problems; chronic overlapping pain conditions; other somatic diseases) or on the disease severity. Categorizing FM as mild, moderate or severe can be based on clinical assessment (e.g. degree of daily functioning) or on questionnaires. Shared decision making regarding treatment options can be directed by patient preferences, comorbidities and availability in various health care settings. European League Against Rheumatism (EULAR) guidelines recommend a tailored approach directed by FM key symptoms (pain, sleep disorders, fatigue, depression, disability), whereas the German guidelines recommend management tailored to disease severity, with mild disease not requiring any specific treatment, and more severe disease requiring multicomponent therapy (combination of drug treatment with aerobic exercise and psychological treatments). When indicated, treatments should follow a stepwise approach beginning with easily available therapies such as aerobic exercise and amitriptyline.

Successful application of a tailored treatment approach that is informed by individual patient characteristics should improve outcome of FM.

Perspective

This article presents suggestions for an individualized treatment strategy for FM patients based on subgroups and disease severity. Categorizing FM as mild, moderate or severe can be based on clinical assessment (e.g. degree of daily functioning) or on questionnaires. Subgroups can be defined by mental health and somatic comorbidities.

Publisher URL: www.sciencedirect.com/science

DOI: S1526590017307009