Fibromyalgia: Diagnostic Criteria, Comorbidities, and Treatment Options
Fibromyalgia: Diagnostic Criteria, Comorbidities, and Treatment Options
Dr. Danish and his team at Philadelphia Integrative Psychiatry regularly engage with patients who are dealing with fibromyalgia. These handouts are crafted drawing from the latest research to provide clear and concise information on various health conditions. While comprehensive, they are intended as an overview, encouraging patients to discuss the content with their healthcare provider for a more personalized approach.
What is Fibromyalgia?
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. It affects millions of people worldwide and can significantly impact the quality of life.
Diagnostic Criteria
To be diagnosed with fibromyalgia, a patient typically must meet the following criteria:
Widespread Pain Index (WPI): is a crucial component in the diagnostic criteria for fibromyalgia, requiring pain to be present in at least 4 out of 5 regions of the body. This index helps clinicians quantify the extent of pain distribution, ensuring a systematic approach to diagnosis. The WPI is instrumental in distinguishing fibromyalgia from other conditions with localized or less extensive pain patterns.
Symptom Severity Scale (SSS): complements the WPI by assessing the severity of fibromyalgia symptoms beyond pain. Patients must achieve a specific minimum score on this scale, which evaluates fatigue, waking unrefreshed, and cognitive symptoms over the past week. The SSS score, combined with the WPI, provides a comprehensive overview of the symptom burden, facilitating a more accurate diagnosis of fibromyalgia.
Duration: Symptoms must be present at a similar level for at least three months.
Exclusion: Other disorders that could cause these symptoms should be ruled out.
These criteria were established by the American College of Rheumatology (ACR) and have been updated over time to improve diagnostic accuracy.
Common Comorbidities
Fibromyalgia often occurs alongside other medical conditions, which can complicate diagnosis and treatment. Common comorbidities include:
Chronic Fatigue Syndrome
Irritable Bowel Syndrome (IBS)
Migraine and other types of headaches
Depression and Anxiety
Temporomandibular Joint Disorders (TMJ)
Potential Medication Treatments
Managing fibromyalgia typically involves a combination of medications and lifestyle changes. Common medications include:
Antidepressants:
These medications have been shown to significantly alleviate symptoms such as pain, fatigue, and sleep disturbances in individuals with fibromyalgia:
Duloxetine (Cymbalta): This serotonin-norepinephrine reuptake inhibitor (SNRI) helps reduce pain and improve mood in patients with fibromyalgia.
Amitriptyline: Often used at low doses, this tricyclic antidepressant aids in pain relief and improves sleep quality for fibromyalgia sufferers.
Anti-seizure Drugs: Pregabalin (Lyrica) and gabapentin (Neurontin) are often prescribed to alleviate pain.
Pain Relievers: Over-the-counter options like acetaminophen and prescription medications such as tramadol can be used, though opioids are generally not recommended due to the risk of dependence.
Acceptance and Commitment Therapy (ACT) Therapy
Acceptance and Commitment Therapy (ACT) is a psychological intervention aimed at increasing psychological flexibility, which is the ability to adapt to changing circumstances and engage in behaviors aligned with one's values despite experiencing negative thoughts and feelings. ACT encompasses six core processes: acceptance, cognitive “defusion”, being present, self as context, values, and committed action. These processes help individuals accept their internal experiences rather than fighting them, reduce the impact and influence of their thoughts, stay mindful of the present moment, view themselves from a broad perspective, identify what truly matters to them, and take actionable steps towards their goals. By fostering these skills, ACT helps individuals manage chronic pain conditions like fibromyalgia, improving their quality of life and psychological well-being.
A recent systematic review and meta-analysis evaluated the efficacy, acceptability, and safety of Acceptance and Commitment Therapy (ACT) in treating fibromyalgia (FM). Six randomized controlled trials (RCTs) with 384 participants were included, assessing primary outcomes like pain acceptance (CPAQ), quality of life (FIQ), attrition rates, and adverse events, and secondary outcomes such as pain intensity, disability, depression, anxiety, and fatigue. ACT, delivered online, in groups, or one-on-one, showed significant improvements in pain acceptance and quality of life both post-intervention and at follow-up. Moderate improvements were observed in pain intensity and disability, with significant gains in depression, anxiety, and fatigue. Attrition rates were generally below 20%, with no adverse events linked to ACT. The meta-analysis confirmed large effect sizes for FIQ and CPAQ post-intervention, indicating substantial benefits in quality of life and pain acceptance. Despite limitations due to the small number of studies and methodological variations, ACT was found to be effective in improving both psychological and physical outcomes for FM patients. Further large-scale RCTs are needed to validate these findings and examine different delivery methods of ACT.
We have many therapists at our practice who specialize in ACT (see profiles for Laura, Alane, and Meghann).
Aqua Therapy
A recent systematic review aimed to evaluate the effects of aquatic exercise programs on pain and quality of life in individuals with fibromyalgia, assessing their potential for inclusion in physical therapy treatment. The review followed PRISMA guidelines and was registered with PROSPERO (CRD42024510219). Conducted in January 2024, the search spanned databases including Cochrane Library, PEDro, PubMed, SCOPUS, and Web of Science using the keywords “aquatic exercise” and “fibromyalgia.” The review included randomized controlled trials (RCTs) published between 2019 and 2024, requiring a minimum PEDro score of 7. Out of 296 initial studies, four RCTs met the criteria, comprising 157 women with an average age of 48.53 years, all diagnosed with fibromyalgia. All studies scored 8/10 on the PEDro scale, indicating high methodological quality and low risk of bias.
Pain and quality of life were assessed using the Visual Analog Scale (VAS), Short Form McGill Pain Questionnaire (SF-MPQ), Short Form-36 Health Survey (SF-36), and Fibromyalgia Impact Questionnaire (FIQ). Additional variables included Beck’s Anxiety Inventory (BAI), Beck’s Depression Inventory (BDI), Fear Avoidance Beliefs Questionnaire (FABQ), and Pittsburgh Sleep Quality Index (PSQI). Intervention protocols varied in duration and frequency, ranging from 6 to 16 weeks with 2-3 sessions per week, including warm-up, aerobic, and strength exercises, often concluding with relaxation. Significant pain reduction and improvements in quality of life were observed across all studies, with additional benefits such as increased flexibility and reduced anxiety levels. The positive outcomes highlight the potential of aquatic exercise as a beneficial treatment for fibromyalgia, attributed to its low-impact nature, comfortable water temperature, and individualized supervision, which enhance patient motivation and adherence.
Functional Medicine Treatment Options
This systematic review followed PRISMA guidelines, including 15 randomized controlled trials (RCTs) that evaluated the efficacy of complementary and alternative medicine (CAM) in treating fibromyalgia (FM). There were many positive results including:
Acupuncture, examined in several studies, showed improvements in FM symptoms, including reductions in fatigue, pain, and tender point sensitivity, as well as enhancements in depression and anxiety.
Tai Chi demonstrated benefits in sleep quality and overall health, with effects lasting up to six months post-treatment.
The oral ingestion of Ganoderma Lucidum (Reishi Mushroom) showed trends towards improved happiness and life satisfaction, although results were not statistically significant.
Japanese Natural Harmonization, specifically Reiki, did not show significant differences in pain, fatigue, or well-being between the control and experimental groups.
Ayurvedic medicine, particularly yoga combined with Tui Na, significantly reduced FM impact and pain, with benefits maintained over the long term.
Balneotherapy (warm mineral baths) improved FM impact, tender points, and perceived pain, especially when combined with physical exercise.
Music therapy enhanced mental well-being but did not significantly affect pain perception.
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