Demystifying Fibromyalgia: What Nurses Need to Know

Fibromyalgia is a potentially disabling, chronic disorder characterized by widespread pain that is often accompanied by fatigue, sleep disturbances, weakness, brain fog, and sensitivity to chemicals. Patients living with the condition often experience depression, loss of vitality, and a decline in cognitive functioning, resulting in poor quality of life

At the 14th Annual Rheumatology Nurses Society Conference, Susan Chrostowski, DNP, APRN, ANP-C, Assistant Clinical Professor, Texas Woman’s University, Dallas, and Adult Nurse Practitioner, Rheumatology, Rheumatology Associates of Texas, Duncanville, provided nurses with a comprehensive overview of fibromyalgia and discussed the importance of using a multidisciplinary and personalized approach to the management of patients with this disorder.

Overview

Fibromyalgia, which affects 2% to 4% of the US population, is the second most common disorder, after osteoarthritis, for which patients are referred to rheumatology subspecialists. Researchers have identified central pain processing abnormalities in the majority of patients who develop fibromyalgia, but these discoveries have not yet led to major breakthroughs in treatment. There may also be a genetic predisposition to fibromyalgia, but further investigation into this hypothesis is required. Anxiety, cognitive stress, posterior insula, iron deficiency, and dietary factors may also contribute to the symptomatology, Dr Chrostowski noted.

Although anyone can develop fibromyalgia, the disorder occurs more frequently in women than in men. Dr Chrostowski said that the reason for this disparity is unknown, but some researchers believe that it may be because women are more likely to experience higher levels of anxiety, altered pain responses, maladaptive coping mechanisms, and hormonal effects related to their menstrual cycles. Unfortunately, these theories probably contribute to the stigmatization of the disorder.

The main takeaway is that the development of fibromyalgia appears to involve the interplay of physical, psychological, genetic, neurobiological, and environmental factors, she noted.

Overcoming Challenges in Diagnosis and Treatment

Dr Chrostowski explained that, historically, the diagnosis of fibromyalgia has been challenging due to a lack of diagnostic tests and biomarkers. However, in 2016, the American College of Rheumatology revised its fibromyalgia criteria to help providers better diagnose the condition (see Table).

table

“If a patient comes in with a complaint of widespread pain and you suspect fibromyalgia, this new tool can be helpful for diagnosis. It can also be used for the assessment of disease activity and response to treatment later on,” she said.

Once a diagnosis has been made, providers are tasked with developing an effective management strategy, which typically includes both pharmacologic and nonpharmacologic elements. Drugs currently approved by the FDA for the treatment of fibromyalgia include pregabalin (Lyrica), duloxetine, and milnacipran (Savella), but these therapies are only moderately successful, leading to a 25% to 40% reduction in pain in approximately 40% to 60% of patients. Only 10% to 25% of patients achieve a 50% reduction in pain.

Non-FDA–approved medications include tricyclic antidepressants (amitriptyline); anticonvulsive, antiseizure, and antispasmodic agents (eg, gabapentin, tizanidine, topiramate); muscle relaxants (eg, baclofen); and analgesics. Cannabis and cannabinoids may prove to be helpful for relieving symptoms, but more research is needed to determine their efficacy.

Nonpharmacologic approaches often include psychotherapy, mindfulness, and exercise. Cognitive behavioral therapy, which is the psychotherapy approach with the most clinical evidence, can help patients develop effective coping strategies and manage stress. Mindfulness may be a better alternative for some symptoms, and appears to have a positive impact on pain, depression, anxiety, and sleep disturbances.

Low-impact exercise, resistance training, and meditative-based therapies, such as yoga, Tai chi, or qigong, can also be effective in reducing depression and improving overall quality of life.

Other nonpharmacologic approaches that may be implemented include spa therapy, acupuncture, transcranial and transcutaneous electrical stimulation, and vibroacoustic and rhythmic sensory stimulation.

“Most of the management strategies discussed here are more effective in combination with patient education,” Dr Chrostowski noted.

A Multidisciplinary and Individualized Approach to Management

Once a diagnosis of fibromyalgia has been made, patients must be reassured that they have a real disease. They also need to understand that fibromyalgia is not universally responsive to drug therapy and there is currently no “cure.”

Dr Chrostowski emphasized that self-management is essential for achieving positive outcomes.

  • A practical approach to management should include the following components:
  • Set reasonable goals and expectations
  • Tailor treatment to the individual patient
  • Provide validation and encouragement
  • Consider multidisciplinary interventions
  • Develop a resource list for patients.

“It is very important to convey understanding and validation. This is a real condition, and we know that it can be difficult for patients. We need them to know that we are here to help them manage it,” she concluded.

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