Highlights
- •Fibromyalgia is a heterogenous condition.
- •There is a need for individualized treatments, because the average effects of any treatments are modest.
- •Individualized treatment of fibromyalgia can be on the basis of subgrouping of patients according to associated medical conditions and on disease severity.
- •Categorizing fibromyalgia as mild, moderate, or severe can be on the basis of clinical criteria or on questionnaires.
- •Shared decision-making on treatment options can be on the basis of patient preferences and comorbidities.
Abstract
The heterogeneity of the clinical presentation and the pathophysiologic mechanisms
associated with fibromyalgia (FM), and the modest results on average for any therapy,
call for a more individualized management strategy. Individualized treatment can be
on the basis of subgrouping of patients according to associated conditions (mental
health problems, chronic overlapping pain conditions, other somatic diseases) or on
disease severity. Categorizing FM as mild, moderate, or severe can be on the basis
of clinical assessment (eg, degree of daily functioning) or on questionnaires. Shared
decision-making regarding treatment options can be directed according to patient preferences,
comorbidities, and availability in various health care settings. The European League
Against Rheumatism guidelines recommend a tailored approach directed by FM key symptoms
(pain, sleep disorders, fatigue, depression, disability), whereas the German guidelines
recommend management tailored to disease severity, with mild disease not requiring
any specific treatment, and more severe disease requiring multicomponent therapy (combination
of drug treatment with aerobic exercise and psychological treatments). When indicated,
treatments should follow a stepwise approach beginning with easily available therapies
such as aerobic exercise and amitriptyline. Successful application of a tailored treatment
approach that is informed by individual patient characteristics should improve outcome
of FM.
Perspective
This article presents suggestions for an individualized treatment strategy for FM
patients on the basis of subgroups and disease severity. Categorizing FM as mild,
moderate, or severe can be on the basis of clinical assessment (eg, degree of daily
functioning) or questionnaires. Subgroups can be defined according to mental health
and somatic comorbidities.
Key words
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Article info
Publication history
Published online: September 21, 2017
Footnotes
W.H. received 1 honorarium for an educational lecture by Grünenthal within the past 3 years. M.-A.F. received consulting fees, speaking fees and/or honoraria from ABBVIE, Abbott, Amgen, Bristol-Myers Squibb Canada, Janssen, Johnson & Johnson, Lilly, and Pfizer. D.J.C. is a consultant for Tonix Pharmaceuticals, Theravance Biopharma, Pfizer Inc, Abbott Laboratories, Samumed, Merck, Eli Lilly and Company, UCB Pharma, Johnson & Johnson, Forest Laboratories, Purdue Pharma, and Zynerba Pharmaceuticals. He has received grants from the National Institutes of Health and Eli Lilly and Company, and has several grants pending with the National Institutes of Health. S.P. received honoraria from Pfizer, Lilly and Grünenthal in the past 3 years.
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© 2017 by the American Pain Society
