Guidelines for the successful management of fibromyalgia patients

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.