Management

Treatment of fibromyalgia should be multimodal and include control of:

1. Pain

2. Affective symptoms

3. Fatigue

4. Interventions to improve dysfunction

Multimodal therapies include the following components:

1. Education of the patient

2. Pharmacological therapies, including the use of tricyclic depressants, serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, tramadol, and anticonvulsants such as gabapentin

3. Alternative therapies such as acupuncture and herbal medications

4. Psychotherapy

5. Physical therapy

6. Treatment of anxiety, depression, and sleep dysfunction, as well as other comorbid conditions

Table 25.1 Effectiveness of pharmacological agents in the treatment of fibromyalgia

The FIQ Directions and Questions

Directions: For questions 1 through 3, please circle the number that best describes how you did overall for the past week.

If you don't normally do something that is asked, cross the question out.

Question 1.

Were you able to:

Always Most

Occasionally

Never

1. Do shopping ?

Ol

2

S

2. Do laundry with washer and dryer ?

Ol

2

S

3. Prepare meals ?

Ol

2

S

4. Wash dishes/cooking utensils by hand ?

Ol

2

S

5. Vacuum a rug ?

Ol

2

S

6. Make beds ?

Ol

2

S

7. Walk several blocks ?

Ol

2

S

8. Visit friends or relatives ?

Ol

2

S

9. Do yard work ?

Ol

2

S

10. Drive a car ?

Ol

2

S

11. Climb stairs ?

Ol

2

S

Question 2. Of the 7 days in the past week, how many days did you feel good ?

0 1 2 3 4 5 6 7

Question 3. How many days last week did you miss

work, including housework, because of fibromyalgia ?

0 1 2 3 4 5 6 7

Table 25.1 (continued)

Directions: For the remaining items, mark the point on the line that beat indicates how you felt overall for the past week.

Question 4. When you worked, how much did pain or other symptoms of your fibromyalgia interfere with your ability to do your work, including housework ?

• i i i i i i i i No problem with work

Great difficulty with work

Question 5. How bad has your pain been ?

• i i i i i i i i No pain

Very severe pain

Question 6. How tired have you been ?

• i i i i i i i i No tiredness

Very tired

Question 7. How have you felt when you get up in the morning ?

• i i i i i i i i Awoke well rested

Awoke very tired

Question 8. How bad has your stiffness been ?

• i i i i i i i i No stiffness

Very stiff

Question 9. How nervous or anxious have you felt ?

• i i i i i i i i Not anxious

Very anxious

Question 10. How depressed or blue have you felt ?

Not depressed

Very depressed

Pharmacotherapy can be used to control the symptoms of pain, fatigue, and affective symptoms. Nonpharmacological therapies are used to increase functionality.

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