Fibromyalgia diagnosis common, but challenging

LAS VEGAS — Fibromyalgia (FM) is one of the most prevalent chronic pain diagnoses in the United States, but there is no single laboratory or physical exam to identify the disorder, according to a speaker at the American Academy of Nurse Practitioners 26th Annual NP meeting.

“Pain is subjective,” said Timothy D. Byrum, MSN, FNP, clinical assistant professor at the University of Alabama in Huntsville. “I have not found a probe yet that I can stick in a person and say: ‘You don't have any pain, you're telling me a story.'”

But FM is real, it is common and it widespread, Byrum said, noting that patients with the disorder normally see between six to nine clinicians for their symptoms before being diagnosed.

As many as 5% of Americans have FM symptoms and most of them are women aged 35 to 60 years.

“Most patients have tenderness to pressure, heat or cold that is similar to arthritis,” Byrum said. But FM is different, because it does not cause inflammation or damage to muscles or joints.

Instead, patients with FM experience widespread, chronic neuropathic pain. Symptoms include tingling, burning, tenderness, stiffness and the presence of tender points that are sensitive to touch, on both the right and left sides of the body.

Diagnosis is based on conducting detailed clinical histories and physical examinations, according to Byrum, who suggested that “pain drawings” might help patients identify where on their body they hurt. Many patients have history of major physical or psychological trauma, Byrum added.

FM patients also suffer sleep deprivation, physical inactivity and memory and other neurocognitive problems, sometimes called “fibro-fog,” Byrum said.

“Pill boxes are not just for the old anymore — I tell my FM patients to use them [to help organize medications] because of the fibro-fog,” Byrum said.

Additionally, many FM patients have a host of psychological, behavioral and other comorbidities that range from psychiatric diagnoses to rheumatoid arthritis to self-medicating with tobacco smoking. But the diagnosis of other diseases does not mean clinicians should abandon a diagnosis of FM, Byrum emphasized.

Although there is no cure for FM, Byrum said that clinicians can help patients with symptom relief. The cornerstones of FM management include promoting physical activity, healthy sleep patterns and pain management.

Currently, only three medications are FDA approved for FM. In 2007, the agency approved pregabalin (Lyrica, Pfizer), an anticonvulsant, with a specific indication for FM indication, followed by the serotonin-norepinephrine reuptake inhibitors duloxetine (Cymbalta, Eli Lilly) in 2008 and milnacipran (Savella, Cyprus Bioscience) in 2009.

Byrum served on the speaker's bureau for Pfizer in 2009 and 2010.

Byrum TD. “Treating fibromyalgia in primary care.” Presented at: 26th Annual American Academy of Nurse Practitioners Conference, 2011: Las Vegas, Nevada.  

Bryant Furlow is a medical writer and award-winning investigative healthcare journalist based in Albuquerque, New Mexico.

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