Page 30 - World of Irish Nursing April 2018

Focus 49

Managing

fibromyalgia

Diagnosis and management of fibromyalgia

can be challenging, write Declan Brennan,

Peter Polydoropoulos and Patrick Murphy

Fibromyalgia has become an increas- of women fulfilled the criteria for socio-eco-
ingly more recognised condition, in a diagnosis of fibromyalgia, with nomic status,
particular over the past two decades. it only 27% being given a diagnosis which can
1
is diagnosed in patients who subjectively of the condition. The analysis fur- collectiv el y
complain of chronic widespread pain of ther concluded that only 2% of influence
a ‘burning’ quality of greater than three women and 0.15% of men were the chronicity of
months. This pain is bilateral, above and actually medically diagnosed symptoms.
below the waist, with multiple tender with fibromyalgia. 7 Diagnosis
points along with a range of symptoms Causes The diagnosis
including persistent fatigue, cognitive The exact cause of fibromyal- and management
dysfunction, functional bowel disorder, gia is not yet known. although of fibromyalgia
non-restorative sleep and mood disorder. no structural or functional is challenging
2,3
it is estimated that 10-20% of the abnormalities in the muscle for both the
population report some kind of chronic mus- tissue are appreciated, increas- patient
culoskeletal pain that cannot be traced to a ing evidence does support
causative factor. Statistics for ireland are dysfunctional pain process-
4
limited, but worldwide prevalence of fibro- ing in the nervous system with
myalgia of 0.4-9.3% has been reported. amplification of pain signals as a
5
The american College of rheumatology key mechanism in the development of
(aCr) and the European league against fibromyalgia.
7
rheumatism (EUlar) have produced abnormal signalling in the pain and
updated guidelines in 2010 and 2016 emotion processing centres of the brain and clinician.
respectively for the diagnosis of fibromyal- such as the thalamus, amygdala and insula it often takes
gia. These are well suited and practical for have been demonstrated on functional more than two
use in general practice. magnetic imaging studies. a likely genetic years for a diag-
7
The aCr 2010 criteria provide a sen- predisposition has also been identified in nosis to be made,
sitivity and specificity of almost 85% in familial studies, where one-quarter of rel- with the patient
separating chronic musculoskeletal pain atives of fibromyalgia patients reported having been seen on
from fibromyalgia. Patients are assessed chronic widespread musculoskeletal pain. 1 average 3.7 times for
by using the widespread pain index that although no one specific gene has been consultations with dif-
divides the body into 19 regions and scores shown to be responsible, emerging evidence ferent physicians. This
8
the number of regions that are reported as is strong for a polygenic effect with genes can put a huge financial
painful. The symptom severity score then affecting the catecholamine, dopamine burden on the healthcare
assesses severity of fatigue, unrefresh- and serotonin pathways playing a role system. Data suggest that
ing sleep, and cognitive symptoms. both and predisposing patients to a dysfunc- in the US total annual costs
the widespread pain index (max. 19) and tional stress response and triggering for patients with fibromy-
symptom severity scores (max. 12) are the clinical symptoms of fibromyalgia. 1 algia average approximately
combined into a single questionnaire with Psychosocial distress has also been US$6,000. it is important
5
scores from 0 to a maximum of 31. a mod- shown to influence the development to note that besides the direct
ified and more useful version of the aCr of chronic pain associated with fibro- medical expenditures, non-med-
2010 (available at www.rheumatology.org) myalgia. The biopsychosocial model ical costs including those incurred
allows for direct patient administration. 6 could therefore explain the expres- by the patient and lost productiv-
Historically, women were assumed to sion of fibromyalgia from its likely ity from work should be taken into
be more commonly affected by fibromyal- genetic factors, to triggers and other consideration.
gia. However, a study from minnesota in factors such as mood disorder, The care of patients with fibromyalgia
7
the US found that 4.9% of men and 7.7% maladaptive behaviour and ideally starts in the primary care setting.