"The psychiatrist confronted with a fibromyalgia patient", Siegfried Kasper. Copyright © 2009 John Wiley & Sons, Inc. Reproduced with permission of John Wiley & Sons, Inc.

Siegfried Kasper

The psychiatrist confronted with a fibromyalgia patient

Human Psychopharmacology: Clinical and Experimental, 2009; 24: S25–S30

key words: fibromyalgia; recognition; symptoms; treatment

Fibromyalgia is usually treated by rheumatologists but since co-morbid depression and anxiety are frequent, psychiatrists are likely to be confronted with patients suffering from the syndrome. The symptoms associated with fibromyalgia vary from patient to patient but there is one common symptom – they ache all over. In addition to pain, patients report headaches, poor sleep, fatigue, depressed mood and irregular bowel habits, which are also all symptoms of depression. For a formal diagnosis of fibromyalgia, the American College of Rheumatology (ACR) criteria require the patient to have widespread pain for at least 3 months together with tenderness at 11 or more of 18 specific tender points. Treatment of fibromyalgia requires a comprehensive approach involving education, aerobic exercise and cognitive behavioural therapy in addition to pharmacotherapy. The most effective drugs available for the treatment for fibromyalgia, the serotonin noradrenaline reuptake inhibitors, milnacipran and duloxetine and the anti-epileptic, pregabalin, are well known to psychiatrists. Thus the psychiatrist is well placed to initiate treatment in these patients.

INTRODUCTION

Fibromyalgia syndrome exists in all ethnic groups and is not limited to affluent or industrialised nations. Current estimates suggest that between 2 and 4% of the general population suffer from the syndrome (Bannwarth et al., 2009; McLean and Clauw, 2005; White et al., 1999;Wolfe et al., 1995). Fibromyalgia sufferers are overwhelmingly women with seven times more women patients than men (White et al., 1999; Wolfe et al., 1995) although this figure may be exaggerated by a diagnostic bias (see below). Thus, in the United States alone, over 10 million women probably suffer from fibromyalgia. If these patients are treated (because many are never diagnosed and treated) it is usually by a rheumatologist or a pain specialist. Comorbid depression (20–80%) and anxiety (13–64%) are, however, common in these patients (Fietta et al., 2007) and it is not unlikely that the psychiatrist will see some of these patients either referred by a rheumatologist or coming to him directly. Although fibromyalgia is not a psychiatric disorder, it is now generally considered that dysfunctional central pain perception is the most likely basic mechanism. In addition chronic pain is being increasingly seen as, at least, a symptom frequently associated with depression and possible an integral part of depressive symptomatology (Stahl and Briley, 2004). Finally, the most effective and bestevaluated medications for the treatment of fibromyalgia are psychotropic drugs that the psychiatrist knows well.

Thus the psychiatrist should be ready to recognise fibromyalgia and to initiate treatment. Many patients will have suffered from fibromyalgia for years and visit numerous physicians before being correctly diagnosed. Even when they are finally diagnosed they often find it difficult to obtain effective therapy. This is not because the treatments are not effective; they are. Simply prescribing the right medication, however, is not enough. The management of fibromyalgia takes a lot of time and involvement on the part of the physician. The successful therapy of fibromyalgia requires a multidisciplinary approach.

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Harvard Health Blog

Getting the best treatment for your fibromyalgia

Text by: Kelly Bilodeau, Former Executive Editor, Harvard Women's Health Watch

Imagine being in pain and none of your doctors can find a clear reason for it. Unfortunately, this is not an uncommon experience for many of the four million Americans living with fibromyalgia, a chronic, painful condition.

People with fibromyalgia experience widespread pain, aches, and stiffness in muscles and joints throughout the body, as well as unusual tiredness. No one knows what causes this condition, and no apparent physical cause has been identified thus far. A leading theory is that it’s due to a brain malfunction that amplifies normal nerve responses causing people with fibromyalgia to experience pain or other symptoms when nothing seemingly triggers them.

For those seeking relief, finding help can sometimes be a challenge. The best way to find a successful treatment strategy is to seek out a doctor who understands fibromyalgia, knows how to treat it, and can help you understand and cope with this condition. Rheumatologists and pain specialists are the experts for this condition, but many primary care doctors diagnose and treat it as well. There are ways that you can improve your chances of finding the right doctor to help you with this condition.

Understand your condition

The first step in this process is to arm yourself with the facts. read more

Enrico Bellato, 1 ,* Eleonora Marini, 1 Filippo Castoldi, 1 Nicola Barbasetti, 1 Lorenzo Mattei, 1 Davide Edoardo Bonasia, 2 and Davide Blonna 1

Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment

Copyright © 2012 Enrico Bellato et al.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities) and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud's phenomenon, irritable bowel disease, and heat and cold intolerance) can be associated with this condition. A careful differential diagnosis is mandatory: fibromyalgia is not a diagnosis of exclusion. Since 1990, diagnosis has been principally based on the two major diagnostic criteria defined by the ACR. Recently, new criteria have been proposed. The main goals of the treatment are to alleviate pain, increase restorative sleep, and improve physical function. A multidisciplinary approach is optimal. While most nonsteroidal anti-inflammatory drugs and opioids have limited benefit, an important role is played by antidepressants and neuromodulating antiepileptics: currently duloxetine (NNT for a 30% pain reduction 7.2), milnacipran (NNT 19), and pregabalin (NNT 8.6) are the only drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. In addition, nonpharmacological treatments should be associated with drug therapy.

Pain Res Treat. 2012; 2012: 426130.
Published online 2012 Nov 4. doi: 10.1155/2012/426130 PMCID: PMC3503476

1. INTRODUCTION

Fibromyalgia is a syndrome characterized by chronic widespread pain at multiple tender points, joint stiffness, and systemic symptoms (e.g., mood disorders, fatigue, cognitive dysfunction, and insomnia) [1–4] without a well-defined underlying organic disease. Nevertheless, it can be associated with specific diseases such as rheumatic pathologies, psychiatric or neurological disorders, infections, and diabetes. What today is defined as fibromyalgia had already been described in the nineteenth century. In 1904, Gowers [5] coined the term “fibrositis” which was used until the seventies and eighties of the last century when an etiology involving the central nervous system was discovered. But it was Graham [6] in 1950 who introduced the modern.

If you would like to read the whole paper click the link → Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment

More to read:

• Galvez-Sánchez C.M. Reyes del Paso G.A. Diagnostic Criteria for Fibromyalgia: Critical Review and Future Perspectives J Clin Med. 2020 Apr; 9(4): 1219.
• Häuser W, Fitzcharles MA: Facts and myths pertaining to fibromyalgia Dialogues Clin Neurosci. 2018 Mar; 20(1): 53–62.