Fibromyalgia PDF

Preface

Fibromyalgia (FM) presents a challenge to health care providers. A heterogeneous condition with uncertain pathophysiology has led to a persistent debate within the medical community regarding FM's nature and validity. FM is underdiagnosed and suboptimally treated with research indicating that patients seeking medical care face multiple barriers. In one investigation involving 76 patients >6O years presenting for a general geriatric clinic visit, only I of 25 patients identified with "probable fibromvalgia" had been previously diagnosed (1). Most patients experience FM symptoms for five to seven years and many consult with multiple physicians prior to diagnosis (2).

FM has received a great deal of attention over the past two decades. Despite the interest in this syndrome, it lacks a clear consensus as to how best to treat patients who meet the diagnostic criteria, and currently there is no known cure. This set of factors makes interactions with patients and successful treatment difficult and demanding. However, FM is recognized as a legitimate clinical entity, and the presence or absence of physician support is likely to exert a strong positive or negative impact on the health of the suffering individuals.

FM consists of many conditions with countless presentations. Scientists are only now beginning to define and analyze its complex biomedical and psychological mechanisms.

In this text, we present a logical flow to assist the primary care provider in his or her encounter with FM patients. Most providers attempt to arrive at a diagnosis through recognition of patterns of symptoms. The various presentations are described with an explanation of why these may differ in patients. The etiology of FM is not fully elucidated but current advances with recent functional MRI findings are described.

Once diagnosed, patients are interested in disease progression. The natural history and pathophysiology of the disease are described in detail The evaluation of the patient includes diseases that can mimic FM. Treatment including nonpharmacologic, complementary, and alternative therapy, and the most recent pharmacologic options and investigational drugs are described.

The most perplexing and difficult issues for the clinicians are psychosocial comorbidities, disability, exercise, and how to motivate the patient to change behavior. All these topics are examined in detail as stand alone articles relevant to the patient encounters occurring frequently in the office.

This book is designed for the primary care provider. The majority of FM patients will present to primary care, receive most treatment in primary care, and even if referred, will likely return to primary care for ongoing management. The primary care provider is best equipped to deal with all the concerns of the FM patient. FM is like many other chronic conditions: it has no cure, quality of life is significantly impaired, patient self-efficacy and acceptance is key to good outcomes, and a caring empathetic provider results in patients who learn to cope despite challenges.

This text is essential reading for the primary provider. Even if one doubts the validity of FM, patients still need evaluation, treatment, hope, and a caring provider. The latest science is important for best outcomes. An approach to the FM patient and treatment options are critical for improved quality of life. We all must accept the challenge of improving the pain and dysfunction in our patients. Presented here is a new approach with valuable guidance to enhance our practice skills in a condition affecting countless numbers of patients.