Fibromyalgia: An Environmental Scan
Table of Contents
4.3.10 Conclusion to A Focus on Fibromyalgia
The symptoms of fibromyalgia tend to vary greatly therefore, it is quite common for a patient to receive treatment from a variety of several different healthcare professionals (See Appendix K for a list of multidisciplinary health care team members). A transdisciplinary health care team consisting of the family physician, nurse practitioner, rheumatologists and a neurologist is best suited for optimal care and management. For this communication among clinicians, having the patient at the ‘centre’ of the care model, an understanding of a shared care plan inclusive of the entire clinical team is paramount. The family physician is ideally suited to treat fibromyalgia because the management of this syndrome requires a longitudinal relationship, openness to various treatment modalities and an overall awareness of the interactions of the environment, the patient’s health literacy and resources available to the patient (Millea and Holloway 2000). Additionally, nurse practitioners are also in a unique position to help identify patients and provide the patient-centered, one on one care that is required to properly diagnose and manage fibromyalgia. The research and development of treatments for fibromyalgia is constantly expanding and changing. Furthermore, tremendous time and knowledge are required to properly diagnose fibromyalgia including understanding the combination of the patient history, physical examination, laboratory evaluations and ruling out other causes of symptoms often confused with fibromyalgia. The family physician and entire health care team requires on-going clinical education and access to up to date clinical information to continue to add to their understanding of symptomology and recommended treatments (Peterson, EL. 2007).
Fibromyalgia has changed in its clinical perception over time. Once thought of as purely a psychiatric progression causing symptoms to a condition comprised of muscle pathology and now is more commonly viewed as a central nervous disorder. It is imperative that fibromyalgia is diagnosed early and treated aggressively as the syndrome can result in long-term chronic health issues and disability. Unfortunately, in many instances pharmacological treatments are ineffective and/or cause significant side effects when drug therapy does work. An over-riding challenge in clinically diagnosis and evaluating effects of therapy is the multifaceted nature of the syndrome and the overlapping symptoms with other chronically painful conditions (Mease, P. 2005). Drug therapy must be multifaceted as no single drug deals with all pathologies. Combinations of drug treatment along with non-pharmacological treatment approaches show the most promising improvements (Krypel, Linda L. 2009). This is extremely problematic for a large portion of individuals suffering with chronic pain including fibromyalgia. Commonly, the burden of illness from CP impacts individuals and their families financially. We know a combination of therapies are most successful in reducing pain and managing symptoms; however, the majority of alternative and complimentary therapies are third party health services whereby, patients must pay all or part of the cost out of pocket. This significantly reduces the access to optimal treatments for many individuals.
Interventions aimed at reducing chronic symptoms for individuals with fibromyalgia must be a combination of education, psychological assistance and exercise, along with medications (Peterson, EL. 2007). There is no cure for fibromyalgia, but treatment aims to reduce symptoms and improve the quality of life. Both individuals with fibromyalgia and clinicians find the lack of standard and universally applicable successful treatments for fibromyalgia very frustrating (Perrot et al. 2008). Therefore, finding the right combination of therapies, having a supportive social network and a strong sense of self-management are necessary for individuals with fibromyalgia to decrease the overall burden of disease.
Despite an increase in various domains of research focused on fibromyalgia, it may appear that the development of effective therapies is slow to produce gold standard treatments (See Appendix L(a) and L(b) for snapshots of global research initiatives regarding chronic pain and fibromyalgia). There is no definitive break-through that will resolve the issues surrounding the diagnosing and treatment issues faced by fibromyalgia patients. No cure is known, no single medication relieves all fibromyalgia symptoms and no specific gene has been isolated as a result of research completed to date.