Today, May 12th, marks Fibromyalgia Awareness Day. Developed by the National Fibromyalgia & Chronic Pain Association (NFMCPA), this international observance day aims to increase public awareness of the disease, and educate patients and the medical community.
Fibromyalgia is a common and chronic disorder characterized by widespread muscle pain, fatigue and multiple tender points. Tender points occur at specific places on the body—on the neck, shoulders, back, hips, and upper and lower extremities— where people with fibromyalgia feel pain in response to slight pressure.
Often patients experience simultaneous conditions including headaches, cognitive impairment, sleep disturbances and irritable bowel and bladder problems. After osteoarthritis, it’s the second most common disorder observed by rheumatologists. It’s estimated to affect one in 20 people worldwide, yet there is no known cause or cure. The persistent and debilitating nature of the disorder can have a devastating effect on peoples’ lives.
The theme for this year’s awareness day – ‘C.A.R.E & Make Fibromyalgia Visible’ – encourages people to Contribute, Advocate, participate in Research, and Educate others about fibromyalgia. Even Sesame street’s Bert and Ernie are spreading the word! We’ve looked back through recent research to take a look at what progress is being made to understand and treat the condition.
Recent studies, aided by significant advances in imaging, have identified differences in how the brain regulates attention and expectation of pain in fibromyalgia patients. There are also abnormal coping strategies and increased cortical activity associated with anxiety, depression and catastrophizing – characterizations of pain as awful, horrible and unbearable.
The message of pain is important because the candidate mechanisms in humans are reversible and should respond to intervention. So which therapy is most effective?
Treatment of fibromyalgia
Developments in the field of pathophysiology of fibromyalgia led to the approval of three analgesics (pain killers) by the US Food and Drug Administration: pregabalin, duloxetine and milnacipran. There are also many other drugs prescribed to fibromyalgia patients, however, which Hauser and colleagues describe in this review.
A recent meta-analysis found that benefits of pharmacological treatments in fibromyalgia are of questionable clinical relevance; many patients discontinue their treatment because of low effectiveness or drug-related adverse effects.
The meta-analysis recommended a combination of pregabalin and non-pharmacological interventions (multicomponent therapy, aerobic exercise and cognitive behavioural therapy) for the management of fibromyalgia.
This supports a study published in 2010 in Arthritis Research & Therapy, that describes an aerobic exercise programme for fibromyalgia patients consisting of land-based or water-based exercises with slight to moderate intensity, two or three times per week for at least 4 weeks. Self-management could also involve meditation, qigong, stress and energy management, and whole body warmth therapy.
With abnormalities in coping and cognitive processing, many view fibromyalgia as a condition that can be engaged with in a simple and harmless way. Is it therefore ethical that money is being spent on drug therapy when mindfulness-based talking therapies are not yet readily available for patients? It seems likely that this debate will continue in the years to come.