What chronic disease management themes for patients with Fibromyalgia?
- 1. A team approach is necessary for meaningful improvement.
Knowledge of local resources can be crucial in providing opportunities for additional patient education and support. Examples include patient support groups, warm water exercise facilities and utilization of clinic staff to help with time-intensive educational programs (registered nurse visits, FM group visits). Comorbid psychiatric disease, IBS, and migraines may require referrals to specialists. Online resources and additional reading materials may be helpful to facilitate self-care. Some studies have shown efficacy of online CBT, which may improve access to this treatment modality.
- 2. Disease management should be viewed as a marathon, not a sprint.
Several symptoms may be present simultaneously at the initial (or subsequent) visit. Focus should be placed on one or two of the most pressing symptoms or functional impairments. With medical therapies and prescriptions for physical activity, “start low and go slow” (many patients with FM experience medication sensitivity/ intolerance). For some patients, the goal of pain relief can become all-encompassing and can hinder efforts to address functional impairments (e.g., an inability to engage in physical activity due to severe pain). Addressing analgesia in such patients is important but should be coupled with education and CBT focused on pain tolerance and advancement of physical activity in the setting of pain.
- 3. The patient has important responsibilities in disease management.
The role of the patient should be clearly outlined through specific expectations regarding activity, sleep hygiene, and self-management. Consider writing recommendations as “prescriptions” to emphasize their importance in relation to pharmacologic therapy.
- 4. The management of FM can be a cyclical process.
Ongoing therapy frequently requires repeated efforts on patient education as well as continued discussion on changing patient goals and management of expectations.
- 5. It is important to recognize that symptom relief does not reside inside a pill bottle.
Evidence suggests that nonpharmacologic therapies offer a higher degree of impact than medication therapy, with data on physical activity and exercise being the most robust. Medicine is a very useful tool in the treatment of FM, but represents only one facet of therapy and does not supplant the need for a multimodal approach to treatment. Emphasizing this fact with patients may help establish realistic expectations for drug therapy, reduce frustration, and increase participation in nonpharmacologic management.
- 6. No single therapy is completely effective for FM, and treatment approaches differ from patient to patient depending on the predominant symptom.