assessment and management of fibromyalgia · 2020-05-12 · pain related to damage of peripheral or...

Assessment and Management of Fibromyalgia

FM-LYR-0023 - 2-0Approved For your personal use. Not for further distribution

2

Program Discussion Points

1. Brown TM, et al. Pain Week® 2010, the Annual Meeting of the ASPE; September 8-11, 2010; Las Vegas, NV; 2. McCarberg BH, et al, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:152-158; 3. Arnold LM, et al. Mayo Clin Proc. 2011;86(5):457-464; 4. McCarberg BH. Am J Therap. 2012;19(5):357–368.

Fibromyalgia (FM) Is Manageable

in the Primary Care Setting1,2

Screening and Diagnostic Tools Are

Available to Facilitate Identification

of Potential FM Patients3,4

Managing FM Can Be Like Managing

Other Chronic Conditions2

Effective Management Integrates

Multimodal Nonpharmacologic and

Pharmacologic Approaches2


3

Potential Benefits of Appropriate Fibromyalgia Management

HCP = Healthcare Provider; 1. Brown TM, et al. Pain Week® 2010, the Annual Meeting of the ASPE; September 8–11, 2010; Las Vegas, NV; 2. McCarberg BH, et al, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:152-158; 3. McCarberg BH. Am J Therap. 2012;19(5):357–368.

Goals of FM Management

• Result in fewer visits to the healthcare provider (HCP) and has the potential to save money for the primary care practice1

• Streamline follow-up visits2

• Empower patients to better manage their disease2,3

• Improve patients’ functional ability2,3


4

Patients with FM Often Present and Seek Ongoing Care in the Primary Care Setting1

1. McCarberg BH, et al, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:152-158.

• Managing FM is similar to managing other complex chronic conditions (e.g., asthma, diabetes)

• Key features of FM and other chronic conditions:• There is no cure• The condition is associated with comorbidities• The condition affects many aspects of patients’ lives

• The condition requires patient self-management• Key features of disease management:

• Pharmacologic therapy• Nonpharmacologic therapy• Patient self-management strategies and behaviors


5

A Chronic Disease Management Framework for Managing FM1

1. Arnold LM, et al. Mayo Clin Proc. 2012;87(5):488-496.

• Integrate disease education with diagnosis

• Provide credible information sources

• Set expectations for patients

• Assess symptom severity

• Prioritize functional areas and symptoms to be treated

• Consider pharmacotherapy as appropriate

• Treat comorbid conditions

• Incorporate nonpharmacologic therapies

• Measure progress against treatment goals

• Adjust treatment plan accordingly

Explain

the Condition

Set Treatment

Goals

Apply Multimodal

Therapy

Track

Progress


6

What Are the Benefits of Engaging the Patient to Understand FM?

1. Sim J, Madden S. Soc Sci Med. 2008;67(1):57-67; 2. Burckhardt CS. Disabil Rehabil. 2005;27(12):703-709; 3. McCarberg BH, et al, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:152-158; 4. Paiva ES, Jones KD. Best Pract Res Clin Rheumatol. 2010;24(3):341-352.

• Diagnosis and subsequent education sets the stage for effective management• Diagnosis provides validation, relief, and reassurance1

• May improve certain outcomes2

• Education provides empowerment, leading to better self-management2,3

• Setting basic expectations for you and your patient can help establish a productive, more efficient partnership, and may minimize frustration4


Pain Pathophysiology


8

Chronic Pain Conditions Can Be Classified Based on Type of Pain Pathophysiology

Three Main Types of Pain Pathophysiology:

Phillips K, Clauw DF. Best Pract Res Clin Rheumatol. 2011;25(2):141-154.Adapted from Stanos et al. Postgrad Med. 2016 Jun;128(5):502-15.

Nociceptive

Pain

Neuropathic

Pain

Sensory

Hypersensitivity

Pain related to damage of somatic or

visceral tissue, due to trauma or inflammation

EXAMPLES:

rheumatoid arthritis, osteoarthritis, gout

Pain related todamage of peripheral

or central nerves

EXAMPLES:

painful diabetic peripheral neuropathy (pDPN),

postherpetic neuralgia

Pain without identifiable

nerve or tissue damage; thought to result from persistent neuronal

dysregulation

EXAMPLES:

fibromyalgia


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Sensory

Hypersensitivity

• Fibromyalgia• Irritable bowel syndrome• Functional dyspepsia• Interstitial cystitis

• Neck and back pain without structural pathology

• Myofascial pain / Temporo-mandibular joint (TMJ) disorder

• Pelvic pain syndrome• Restless legs syndrome• Headaches• Chronic fatigue syndrome

• Gout• Osteoarthritis • Rheumatoid arthritis• Tendonitis, bursitis• Ankylosing spondylitis • Tumor-related

nociceptive pain• Neck and back pain with structural

pathology• Sickle-cell disease• Inflammatory bowel disease

Nociceptive

Pain

• Postherpetic neuralgia• Painful diabetic peripheral

neuropathy• Sciatica/stenosis• Spinal cord injury pain• Tumor-related neuropathy• Chemotherapy-induced

neuropathy• Small-fiber neuropathy• Post-stroke pain• Multiple sclerosis pain• Persistent postoperative pain

Neuropathic

Pain

The Three Types of Pain, Separately or Together, Give Rise to Various Chronic Pain Conditions

Chronic low back pain

has been acknowledged to have multiple potential mechanisms and is often viewed as a prototypical “mixed-pain state”

Adapted from Stanos et al. Postgrad Med. 2016 Jun;128(5):502-15FM-LYR-0023 - 2-0

Approved For your personal use. Not for further distribution

10

FM Is the Prototype “Sensory Hypersensitivity” Condition

1. Arnold LM, et al. Mayo Clin Proc. 2011;86(5):457-464; 2. Staud R, et al. Arthritis Research & Therapy. 2006;8(3):208.

• Patients with FM often exhibit1,2:• Pain in multiple body regions• Multiple somatic symptoms

• E.g., Fatigue, memory difficulties, sleep problems, mood disturbance

• Higher current and lifetime history of chronic pain inseveral body regions

• Family history of chronic pain• More sensitive to other sensory stimuli

• E.g., Bright light, loud noises, odors

• Pain may be triggered or exacerbated by stressors• Generally normal physical examination except for diffuse tenderness and nonspecific

neurologic signs


Identifying the FM Patient


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Clinical Features of FM

1. Leavitt F, et al. Arthritis Rheum. 1986;29(6):775-781; 2. Staud R. Arthritis Res Ther. 2006;8(3):208-214; 3. Wolfe F, et al. Arthritis Rheum. 1995;38(1):19-28; 4. Yunus MB. Semin Arthritis Rheum. 2008;37(6):339-352;5. Vadivelu N, et al, eds. Essentials of Pain Management. New York, NY: Springer Science; 2011:57-74.

• CORE criteria of FM• Pain is in all 4 quadrants of the body ≥3 months

• Patient descriptors of pain include:• Aching, exhausting, nagging, and hurting

• Sensitivity to pressure stimuli• Tender point exam given to assess tenderness

• Features of FM• Hyperalgesia• Allodynia

• Fatigue3

• Pain-related conditions / symptoms• Chronic headaches / migraines• Subjective morning stiffness

• Neurologic symptoms• Subjective, tingling in extremities

• Sleep disturbances• Non-restorative sleep, RLS

Other

Symptoms

Other

Symptoms3,4,5

Chronic

Widespread

Pain1

Tenderness2,3


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FM Often Seen with Other Chronic Medical Conditions

1. Chakrabarty S, Zoorob R. Am Fam Physician. 2007; 76(2):247-254; 2. Hershfield NB. Can J Gastroenterol. 2005; 19(4):231-234; 3. Weir PT, et al. J Clin Rheumatol. 2006; 12(3):124-128; 4. Mease P. J Rheumatol. 2005; 32 (suppl 75):6-21.

• Other Pain States1

• IBS• Headaches / migraines

• Infection and Inflammation2

• Crohn’s disease

• Psychological Disorders1

• Depression• Anxiety disorders

• Rheumatic Disorders3

• Rheumatoid arthritis• Systemic lupus erythematosus

Consider FM in patients with chronic conditions who also suffer

from chronic widespread pain, fatigue, and sleep disturbances4


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Screening Tools for Identifying Potential FM Patients

1. Arnold LM, et al. Mayo Clin Proc. 2011;86(5):457-464; 2. Data on file. Pfizer Inc. FibroDetect; 2011; 3. Wolfe, et al. J Rheumatol. 2011;38(6):1113-1122; 4. White KP, et al. J Rheumatol.1999;26(4):880-884.

• Proper screening is a critical first step to managing fibromyalgia1

• Several validated screening tools include:• FibroDetect2

• Fibromyalgia Survey Questionnaire (FSQ)3 – ACR 2010 modified for patient report

• London FM Epidemiology Study Screening Questionnaire (LFES-SQ)4

These screening tools are provided to inform choice and their use is not prescriptive. They

are not a clinical diagnosis, nor designed to take the place of a physician consultation.3,4


15

1990 American College of Rheumatology (ACR) Classification Criteria for Fibromyalgia1

1. Wolfe F, et al. Arthritis Rheum. 1990;33(2):160-172.

• The 1990 ACR criteria for the classification of FM include:• Chronic widespread pain (Core feature) for ≥3 months

• Pain above and below the waist

• Pain on left and right sides of body

• Pain in the axial skeleton

• Pain at ≥11 of 18 tender points when palpated with 4 kg/cm2

of digital pressureDiagram Showing 18 Tender Points

The 1990 ACR criteria are1:

Sensitive (88.4%) – Proportion of patients correctly identified as having the conditionSpecific (81.1%) – Proportion of patients correctly identified as not having the condition


16

2010 ACR Preliminary Diagnostic Criteria for FM1

1. Wolfe F, et al. Arthritis Care Res. 2010;62(5):600-610.

• According to the 2010 ACR preliminary criteria, FM can be diagnosed based on a HCP-administered questionnaire:• Widespread pain index (WPI)

• The number of painful body regions

• Symptom severity (SS) scale that assesses the severity of:• Fatigue• Waking unrefreshed• Cognitive symptoms• Quantifies the occurrence of other somatic symptoms

• Pain and symptoms present for 3 months or longer

The 2010 preliminary ACR criteria1:

Not meant to replace current ACR classification criteria, but to offer an alternative method of FM diagnosis Accurately identified 88% of the same FM cases initially identified by the 1990 ACR classification criteria


17

ACR: Two Types of Classification and Preliminary Diagnosis Criteria for FM

1. Wolfe F, et al. Arthritis Rheum.1990;33(2):160-172; 2. Wolfe F, et al. Arthritis Care Res. 2010; 62(5):600-610.

Parameter 1990 Classification Criteria1 2010 Preliminary Diagnostic Criteria2

Consider Pain to Be a

Central Symptom of FMYes

YesAlthough definition of FM is broadened

to include other symptoms

Include Assessment of Symptoms

Other Than Pain in DiagnosisNo

YesSymptom Severity Scale assesses somatic symptoms such as fatigue, sleep, cognition

Specify Use of a Tender

Point ExamYes

NoHowever, a physical exam is recommended for all patients

• A May 2010 article in Arthritis Care & Research proposed new criteria for the diagnosis of FM2

• Among the objectives of the study was to identify non-tender point diagnostic criteria2

• These criteria are not intended to replace the 1990 ACR Classification Criteria, but to represent an alternative method of diagnosis2


Managing the Fibromyalgia Patient


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Manage Expectations Upfront

1. McCarberg BH, et al, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:152-158; 2. Arnold LM, et al. Mayo Clin Proc. 2012;87(5):488-496.

• Goal of treatment = improvement in function and symptoms (not cure)1

• FM is dynamic, with potential for flare-ups and setbacks2

• Process of care utilizes a collaborative healthcare team2

• The patient is a critical member of this team

• Other expectations may include:• Frequency of office visits

• How much time will be available at each visit

• Prioritization of goals

• Position on disability

Expectations Regarding

the Course of Disease

Expectations Regarding

the Treatment Process


20

What Are the Benefits of Setting Meaningful Treatment Goals?

1. McCarberg BH, et al, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:152-158; 2. Arnold LM, et al. Mayo Clin Proc. 2012;87(5):488-496; 3. Burckhardt CS. Disabil Rehabil. 2005;27(12):703-709; 4. Filoramo MA. Pain Manag Nurs. 2007;8(2):96-101.

• Goal setting helps focus and streamline follow-up visits1,2

• Provides a plan of action• Focuses the patient on targeted functional outcomes• Provides structure for follow-up visits

• Appropriate goals for FM management2,3

• Specific• Realistic• Measurable• Reflect the patient’s priorities

• Have a target date for completion• Aim for improved functionality in key domains

• Assess potential barriers and help the patient problem-solve to minimize them4


21

Tools to Document Baseline Status and Manage Treatment Progress

1. Bennett RM, et al. Arthritis Res Ther. 2009;11(4):R120; 2. Boomershine CS, Crofford LJ. Nat Rev Rheumatol. 2009;5(4):191-199; 3. Wolfe F, et al. Arthritis Care Res. 2010;62(5):600-610; 4. Johnson C. J Chiropr Med. 2005;4(1):43-44.

Tool Description

Revised Fibromyalgia Impact

Questionnaire (FIQR)1• 21 questions to assess functional status and symptoms over previous 7 days• Can be used to track specific functional domains or symptoms at initial assessment and at each visit

thereafter• Physician or office staff administer, taking <2 minutes

Modified Visual Analog Scale

of the Fibromyalgia Impact

Questionnaire (mVASFIQ)2

• Quantifies the severity of individual FM symptoms• Provides the basis for initial treatment plan• Identifies most bothersome symptoms• Patients can complete, taking <2 minutes

ACR 2010 Preliminary

Diagnostic Criteria3• Comprises widespread pain index (WPI) and 2 symptom severity (SS) scales• Provides alternative FM diagnostic criteria to ACR Tender Point Exam; SS portion may be used to track

progress over time• Valid, reliable diagnostic tool; not yet validated for tracking progress• Physician or office staff administer

Numeric Rating Scale (NRS)4 • Can be used to assess functional impact / symptom severity • Values directly entered into patient’s chart or electronic medical record• Patient can complete, taking <2 minutes


The Multimodal Approach


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Why Apply Multimodal Therapy?

1. Arnold LM, et al. Mayo Clin Proc. 2011;86(5):457-464; 2. Mease P. J Rheumatol. 2005;32 (Suppl 75):6-21; 2. Mease P. J Rheumatol. 2005;32(suppl 75):6-21.

Sleep disturbance1

Chronic widespread pain and tenderness1

Mood disturbance1

Morning stiffness1

Fatigue1

No single treatment approach for FM targets every symptom;

a multimodal treatment approach can enhance care

and maximize results2


24

Key Facets of the Multimodal Treatment Approach

1. Arnold LM, et al. Mayo Clin Proc. 2012;87(5):488-496; 2. Goldenberg DL. Clinical Management of Fibromyalgia. 1st ed. West Islip, NY: Professional Communications, Inc; 2009; 3. Jones KD, et al. Rheum Dis Clin North Am.

2009;35(2):373-391; 4. Mease P. J Rheumatol. 2005;32(suppl 75):6-21.

Be proactive and prepared:

Know your patient, team,

and community1

Promote nonpharmacologic

therapies for FM management1

Offer strategies

to improve adherence

to physical activity3

Maximize the effectiveness

of pharmacotherapy2

Provide sleep

hygiene advice4


25

Management of FM: A Multidisciplinary Approach

1. Goldenberg DL, et al. JAMA.2004;292(19):2388-2395; 2. Arnold LM, et al. Mayo Clin Proc. 2012;87(5):488-496; 3. American Chronic Pain Association. ACPA Fibro Log. 2009; 4. Williams DA, et al. In: McCarberg BH, Clauw DJ, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009.

Treatment

Approaches

• Pharmacotherapy1 • Patient education2,3

• Diet / nutrition• Sleep hygiene• Management of expectations• Journaling

• Cognitive behavioral Therapy4

• Biofeedback• Communication skills training

• Alternative / complementary1

• Massage• Acupuncture • Chiropractic

• Exercise1

• Cardiovascular exercise• Strength training• Stretching


26

Pharmacotherapy

1. Arnold LM, et al. Mayo Clin Proc. 2012;87(5):488-496; 2. Boomershine CS, et al. Nat Rev Rheum. 2009;5(4):191-199.

General Strategies When Initiating Medication Therapy

• Evaluate previous or existing pharmacological / nonpharmacological therapies:• Determine if previous drug treatment trials were adequate (Duration and dose)

• Consider potential drug interactions

• Educate patients regarding rationale for medication therapy1

• To help manage medication intolerance2:• Start with one drug at a time

• Initiate at lower dose and titrate up

• Discuss strategies for managing side effects

• If more than one medication is needed, be aware of potential drug interactions2


27

Integrate Patient Education into Practice

1. D’Arcy Y, et al. J Nurse Pract. 2005;1(4):218-225.

Plan and Make

Optimal Use of

Existing Resources

Provide supplemental education

• Patient advocacy organizations• Group education programs• Suggested reading / resources• Use of supplemental support staff

Provide patients with

educational literature1

Review educational

messaging with patients

Have patients do their

own research and

bring in questions


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Patient Education

1. Arranz LI, et al. Rheumatol Int. 2010;30(11):1417-1427; 2. Ko GD. Clin J Pain. 2010; 26(2):168-172; 3. Harding SM. Am J Med Sci. 1998;315(6):367-376; 4. Williams DA, et al. In: McCarberg BH, Clauw DJ, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:136-151.

• Foods to recommend: Fruits and vegetables, possibly omega-3 containing fish, multi-vitamins

Diet / Nutrition1,2

• 76% of FM patients report sleep problems• Counsel patients to:

• Keep a regular sleep schedule and reserve bed for sleeping• Keep bedroom quiet, dark, and at a comfortable temperature

Sleep Hygiene3,4


29

• Goal setting

• Coping strategies to get through flares

• Myths and misconceptions discussion

Patient Education

1. American Chronic Pain Association. ACPA Fibro Log. 2009; 2. Burckhardt CS. Disabil Rehabil. 2005;27(12):703-709; 3. McCarberg BH, et al, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:152-158.

• Keeping track of stress, activities, sleep, weather, etc., can help patients recognize and understand pain triggers and other symptoms

• This may empower them to control / minimize their pain

Journaling1

Management of Patient Expectations2,3


30

Exercise Recommendations

• Studies have shown that physical fitness reduces FM symptoms through1:• Decreased pain sensitivity

• Increased tolerance to pain

• Muscles that are less susceptible to damage

• Appropriate exercises1,2:• Low impact activity

• e.g., Walking, water running, bicycling

• Strength training• Avoid eccentric muscle contractions

• Stretching• Stretch to feel tightness but not pain

• Hold for 20 to 30 seconds

1. McCarberg BH, et al, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:128-135; 2. Busch AJ, et al. J Rheumatol. 2008;35(6):1130-1144


31

Alternative / Complementary

1. Kalichman L. Rheumatol Int. 2010;30(9):1151-1157; 2. Castro-Sánchez AM, et al. Evid Based Complement Alternat Med. 2011:561753.

• Myofascial release, connective tissue, and manual lymph drainage massages have all shown to significantly decrease pain scores in FM patients

• All massages should be conducted PAIN FREE!!

• Benefits are short-lived; for maximum benefit, have 1–2 massage sessions/week

Massage1,2


32

Alternative / Complementary

1. Langhorst J, et al. Rheumatology. 2010;49(4):778-788; 2. Terry R, et al. Clin Rheumatol. 2012;31(1):55-66.

• Acupuncture and chiropractic therapies are not recommended for FM patients

Scientific Evidence Suggests That Chiropractic Therapies Do Not Significantly

Improve Pain Control in FM Patients with Mixed Findings for Acupuncture1,2


33

Cognitive Behavioral Therapy (CBT)1

1. Bennett R. Nat Clin Pract Rheumatol. 2006;2(8):416-424.

• Focuses on two treatment aspects:• “Increasing a patient’s sense of personal control over their pain

• Decreasing dysfunctional thought patterns, such as those involved in ‘catastrophizing’

(i.e., exaggerating the significance of a negative event) about the pain and its effects and associated behavioral improvements in function”

• Studies have shown CBT significantly improves self-efficacy, coping strategies, and physical function in FM patients

• It may be considered as an adjunctive therapy in the management of FM patients who are emotionally distressed


34

Cognitive Behavioral Therapy (CBT)1

1. Bennett R. Nat Clin Pract Rheumatol. 2006;2(8):416-424.

• Educate patients about the pathophysiology of FM (e.g., sensory hypersensitivity) and interaction between emotions, behavior, and cognition in coping and functioning

• Realistic goal setting for work, social, and family interactions• Relaxation training• Appropriate behavioral pacing of activities (Not over- or under-do) • Identification of dysfunctional thought patterns and techniques to counter negative

automatic thoughts• Communication skills training• Strategies for relapse prevention and for managing painful flare-ups

Key Elements for FM


Follow-up


36

What Is the Advantage of Tracking Patient Progress?

1. Harris RE et al. Arthritis Rheum. 2005;52(11):3670-3674; 2. Arnold LM, et al. Mayo Clin Proc. 2012;87(5):488-496.

Imp

rovem

en

tFunction

Symptom

Severity

Time

The course of FM is often not straightforward1; tracking progress

helps keep patients from getting discouraged and helps monitor

the effectiveness of the treatment plan2

Imp

rovem

en

t


37

Follow-up Visits Should Be Structured to Track and Promote Progress

1. Arnold LM, et al. Mayo Clin Proc. 2012;87(5):488-496; 2. McCarberg BH, et al, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:152-158.

• Structure office visits to focus on desired functional outcomes and monitoring symptoms in key domains1

• Ask patients about their physical activity levels and how much they use self-management techniques1

• Use each visit to assess the progress of the patient’s goals to cover important education

and self-help topics2

• Encourage patients to take ownership for managing FM by giving simple “homework”


38

Treatment Adherence in Fibromyalgia

1. Dobkin PL, et al. Clin J Pain. 2006;22(3):286-294; 2. Sewitch MJ, et al. Rheumatology. 2004;43(5):648-654.

• A prospective study of 142 women with FM showed that adherence to both medications and general treatment (e.g., exercise) was poor1

• About 50% of patients were non-adherent to medicines

• Another prospective study of 127 women with FM assessed factors affecting medication non-adherence2

• About 1/3 of patients were intentionally and unintentionally non-adherent

• Patients diagnosed with FM are often on multiple medications, which may contribute to poor adherence1,2

• 70% to 80% are on 3 or more medicines while 9% to 20% are on over 8 medicines


39

Predictors of Adherence

1. Dobkin PL, et al. Clin J Pain. 2006;22(3):286-294; 2. Dobkin PL, et al. J Rheumatol. 2008;35(11):2255-2264.

• A composite of barriers to treatment such as time, effort, stress, social support, cost, pain, and self-motivation contribute to overall treatment adherence1,2

• A greater sense of self-efficacy (self-confidence) is associated with increased levels of adherence2

• Lower discordance between patient and physician perception of disease and treatment is associated with increased levels of adherence1

• A multimodal approach to treatment results in increased treatment adherence and positive outcomes2


40

Enhancing Treatment Adherence in Patients with FM

1. Dobkin PL, et al. Clin J Pain. 2006;22(3):286-294; 2. Sewitch MJ, et al. Rheumatology. 2004;43(5):648-654; 3. Dobkin PL, et al. J Rheumatol. 2008;35(11):2255-2264.

• Ensure patient has a thorough understanding of FM and is involved in treatment decisions1

• Educate patient on the role of treatment and set realistic expectations and timelines with regard to treatment outcomes2

• Utilize a multimodal approach to treatment3

• For example, nursing, physiotherapy, occupational therapy, and psychology have been used to provide disease education, coping skills, stress management skills, and fitness training3


41

Enhancing Treatment Adherence in Patients with FM

1. Rooks D. Curr Opin Rheumatol. 2007;19(5):111-117; 2. Haynes RB, et al. JAMA. 2002;288(22):2880-2883; 3. Dobkin PL, et al. J Rheumatol. 2008;35(11):2255-2264.

• Individualize treatment regimens (e.g., custom tailor exercise programs)1

• Simplify medication dosing regimens2

• Provide written and verbal instructions and use reminder aids2

• Identify, discuss, and reduce potential barriers to treatment such as time constraints, psychological stress, lack of social support, cost, and low motivation3

• Seek to instill a sense of patient self-efficacy (self-confidence)3


42

Summary

1. Brown TM, et al. Pain Week® ‘10, the Annual Meeting of the ASPE; September 8–11, 2010; Las Vegas, NV; 2. McCarberg BH, et al, eds. Fibromyalgia. New York, NY: Informa Healthcare; 2009:152–158; 3. Arnold LM, et al. Mayo Clin Proc. 2011;86(5):457-464; 4. McCarberg BH. Am J Therap. 2012;19(5):357–368.

FM Is Manageable in

the Primary Care Setting1,2

Screening and Diagnostic Tools Are

Available to Facilitate Identification

of Potential FM Patients3,4

Managing FM Can Be Like Managing

Other Chronic Conditions2

Effective Management Integrates

Multimodal Nonpharmacologic and

Pharmacologic Approaches2

PBP665503-01 © 2014 Pfizer Inc. All rights reserved. June 2014. FM-LYR-0023 - 2-0

Approved For your personal use. Not for further distribution

assessment and management of fibromyalgia · 2020-05-12 · pain related to damage of peripheral or...

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