Editor's comment: This report, issued by the Canadian Pain Society and Canadian Rheumatology Association, appears to be a summary of the "New Canadian Guidelines for Treating Fibromyalgia" released in May 2013.
Canadian Pain Society and Canadian Rheumatology Association Recommendations for Rational Care of Persons with Fibromyalgia. A Summary Report.
By Mary-Ann Fitzcharles, et al.
OBJECTIVE: To summarize the development of evidence-based guidelines for the clinical care of persons with fibromyalgia (FM), taking into account advances in understanding of the pathogenesis of FM, new diagnostic criteria, and new treatment options.
METHODS: Recommendations for diagnosis, treatment, and patient followup were drafted according to the classification system of the Oxford Centre for Evidence-Based Medicine, and following review were endorsed by the Canadian Rheumatology Association and the Canadian Pain Society.
FM is a polysymptomatic syndrome presenting a spectrum of severity, with a pivotal symptom of body pain.
FM is a positive clinical diagnosis, not a diagnosis of exclusion, and not requiring specialist confirmation.
There are no confirmatory laboratory tests, although some investigation may be indicated to exclude other conditions.
Ideal care is in the primary care setting, incorporating nonpharmacologic and pharmacologic strategies in a multimodal approach with active patient participation.
The treatment objective should be reduction of symptoms, but also improved function using a patient-tailored treatment approach that is symptom-based.
Self-management strategies combining good lifestyle habits and fostering a strong locus of control are imperative.
Medications afford only modest relief, with doses often lower than suggested, and drug combinations used according to clinical judgment.
There is a need for continued reassessment of the risk-benefit ratio for any drug treatment.
Outcome should be aimed toward functioning within a normal life pattern and any culture of disablement should be discouraged.
CONCLUSION: These guidelines should provide the health community with reassurance for the global care of patients with FM with the aim of improving patient outcome by reducing symptoms and maintaining function.
Source: Journal of Rheumatology, July 1, 2013. By Mary-Ann Fitzcharles, Peter A. Ste-Marie, Don L. Goldenberg, John X. Pereira, Susan Abbey, Manon Choinière, Gordon Ko, Dwight E. Moulin, Pantelis Panopalis, Johanne Proulx and Yoram Shir. From the Division of Rheumatology, McGill University, Montreal, Quebec; Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec; Faculty of Law, Université de Montréal, Montreal, Quebec, Canada; Division of Rheumatology, Tufts University School of Medicine, Boston, Massachusetts, USA; Faculty of Medicine, University of Calgary, Calgary, Alberta; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario; Centre de la recherche du Centre hospitalier de l'Université de Montréal, and Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec; Division of Physiatry, University of Toronto, Toronto, Ontario; and departments of Clinical Neurological Sciences and Oncology, University of Western Ontario, London, Ontario, Canada.