Guidelines for the successful management of fibromyalgia patients

Robert (Rob) Bennett

    Research output: Contribution to journalReview article

    1 Citation (Scopus)

    Abstract

    The successful management of fibromyalgia starts with establishing a firm diagnosis, followed by an evaluation of all other comorbid pain conditions (e.g. osteoarthritis, temporomandibular pain disorder, migraine headaches, myofascial trigger points) and fibromyalgia associated comorbidities (e.g. restless leg syndrome, irritable bowel syndrome). Then, it is necessary to systematically go through a list of problems that need to be addressed: pain, sleep, fatigue, mood disorders, cognitive dysfunction, functional limitations, social functioning, prior therapies and expectations. The most fundamental issue in successful management is initiating patient directed therapies. This involves education regarding the nature of fibromyalgia, the various tools for treating different aspects of the disorder and the development of a constructive and flexible treatment program that will be modified according to the results. All fibromyalgia patients should be given a trial of medications that have been shown to help pain. Non-restorative sleep diminishes the effectiveness of the descending inhibitory pain pathway, thus effective treatment is an essential component of pain management, as well as helping fatigue and cognition. It is important to rule out treatable associated sleep disruptors such as restless legs syndrome and sleep apnea. The basis of attaining effective sleep is the patient's adherence to basic sleep hygiene measures. Cognitive behavioral therapy where feasible, should be pursued. Ideally, hypnotics should be used as a short-term bridge while the patient is establishing behavioral modifications. Regular gentle exercise has repeatedly been shown to benefit fibromyalgia patients and needs to be incorporated in every patient's management strategy. Practicing mindfulness is a useful strategy for minimizing stress and can be incorporated into gentle exercise in the form of yoga and Tai chi. Having fibromyalgia creates an existential crisis for most patients, the management of these clients can be a rewarding experience for the well-informed and empathetic physician.

    Original languageEnglish (US)
    Pages (from-to)S13-S21
    JournalIndian Journal of Rheumatology
    Volume9
    Issue numberS2
    DOIs
    StatePublished - Dec 1 2014

    Fingerprint

    Fibromyalgia
    Guidelines
    Sleep
    Restless Legs Syndrome
    Pain
    Fatigue
    Tai Ji
    Exercise
    Trigger Points
    Yoga
    Mindfulness
    Temporomandibular Joint Disorders
    Somatoform Disorders
    Irritable Bowel Syndrome
    Sleep Apnea Syndromes
    Cognitive Therapy
    Pain Management
    Therapeutics
    Patient Compliance
    Hypnotics and Sedatives

    Keywords

    • Fibromyalgia
    • Guidelines
    • Management
    • Sleep hygiene

    ASJC Scopus subject areas

    • Rheumatology

    Cite this

    Guidelines for the successful management of fibromyalgia patients. / Bennett, Robert (Rob).

    In: Indian Journal of Rheumatology, Vol. 9, No. S2, 01.12.2014, p. S13-S21.

    Research output: Contribution to journalReview article

    Bennett, Robert (Rob). / Guidelines for the successful management of fibromyalgia patients. In: Indian Journal of Rheumatology. 2014 ; Vol. 9, No. S2. pp. S13-S21.
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