Fibromyalgia is a chronic disorder characterized by fatigue, difficulty sleeping, widespread pain in a variety of places, stiffness and swelling. According to the American College of Rheumatology, fibromyalgia mainly affects women and is reported in 2 to 4 percent of the population. The federal government has developed fibromyalgia treatment guidelines that are available through the National Guideline Clearinghouse.
Assessment
Before prescribing any form of treatment, a physician should get a complete history from the patient, including the nature, severity and location of the ongoing pain, how the patient's sleep is disrupted, what other trauma the patient has undergone and how daily functioning is affected by the symptoms. A past medical history should be completed, and information should be gathered about any previous fibromyalgia treatments. A family history of diseases such as arthritis, hypothyroidism, psychological disorders and migraines should be collected. In addition, the government requires a psychosocial history of the patient that includes an evaluation of the patient's coping skills, financial support, previous stress or trauma, lifestyle choices, and level of emotional stability.
Examination
In addition to checking vital signs and observing the patient's appearance, the fibromyalgia treatment guidelines require that doctors perform a complete examination of every joint; palpate tender spots; and assess the patient's mental status through a psychological evaluation, looking for symptoms of depression, anxiety and migraine headaches. Doctors also should get complete gynecological and neurological exams to eliminate other conditions. A Fibromyalgia Impact Questionnaire should be administered, as well as extensive lab tests and a sleep analysis.
Diagnosis
To receive a diagnosis of fibromyalgia, patients must meet certain criteria that include a history of widespread pain that has been ongoing for at least three months. Widespread pain is characterized by pain on both sides of the body and above and below the waistline as well as skeletal pain in the spine or lower back. Patients must present with tenderness in 11 of the 18 points identified by the American College of Rheumatology for fibromyalgia patients.
Treatment
The first line of treatment for fibromyalgia sufferers is sleep medication with drugs such as amitriptyline. Fatigue and depression can be treated pharmacologically with seratonin reuptake inhibitors. Muscle spasms and pain also can be treated with medications. Exercise and massage are recommended for fibromyalgia patients, including cardiovascular workouts, muscle building and stretching. Massage and biofeedback also have proved successful in treating the disorder. Referrals to pain management specialists and psychologists may be required for patients who do not respond to regular treatment modalities.
