Despite the fact that a great deal has been learned about the pathophysiologic mechanisms involved in fibromyalgia in recent years, many primary care physicians (PCPs) are still reluctant to diagnose and treat FM patients. As a result, it is estimated that FM remains undiagnosed in as many as three out of four people who have it. And it is still taking an average of five years to get an accurate diagnosis.
For this reason, in 2009 a diverse group of medical, professional and patient advocacy organizations got together for the purpose of improving the recognition, diagnosis and management of people with fibromyalgia. Together in 2010, they developed The FibroCollaborative Roadmap for Change: A Call to Action for Fibromyalgia.
Following the recommendations outlined in the FibroCollaborative Roadmap, three papers were published by FM specialists in the Mayo Clinic Proceedings that update PCPs on the pathophysiologic mechanisms involved in fibromyalgia and guide them on how to recognize, diagnose and manage people with FM.
Each of these papers is exceptionally well-written, concise and evidence-based. Not only are they excellent guides for physicians but they are also wonderful resources of information for patients as well.
The link for each paper described below will take you to a full-text version of the paper. There you can also download a PDF of the article as it appeared in the printed version of the Mayo Clinic Proceedings if you would like to take a copy to your doctor.
1. Improving the Recognition and Diagnosis of Fibromyalgia (May 2011)
This first paper instructs the physician in how to recognize FM, covering both patient history and physical examination. Instructions are given for the formal tender point exam as well as the more recently proposed clinical diagnostic criteria for FM that doesn't rely on counting tender points. Comorbid conditions and when/if to use laboratory tests are discussed as well.
2. The Science of Fibromyalgia (September 2011)
The second paper delves into the pathophysiologic mechanisms of FM. Normal pain processing is compared to pain processing in FM. Central sensitivity and pain amplificaton are discussed as are the pharmacological mechanisms for analgesia.
This third and final paper, just released, provides a framework or outline for managing the care of FM patients. Some of the information covered includes:
Books and Internet resources to recommend to patients
Setting treatment goals
Importance of a multimodal treatment approach
Tables describing the use and benefits of both drug and non-drug therapies
Importance of tracking progress
A flow-chart of the core principles for an integrated approach for FM management
In My Opinion...
If you have fibromyalgia, I would encourage you to download the PDFs of these papers and perhaps print a copy to share with your primary care physician. Not only do they contain the best summary of information about FM I've seen, but every point made is footnoted with appropriate references to the medical literature your doctor will want to see.