The nature of the pain experienced by patients with fibromyalgia, how to treat it, and the importance of exercise and tailored patient care were the focus of two talks at the American College of Rheumatology (ACR)/Association of Rheumatology Health Professionals (ARHP) Annual Meeting, in Washington, D.C.
In his presentation, Daniel J. Clauw, MD, a rheumatologist and professor of anesthesiology and medicine and director of the Chronic Pain and Fatigue Research Center at the University of Michigan, focused on the nature of pain and how clinicians can help patients.
Three pain categories were emphasized during his talk: peripheral pain, peripheral neuropathy, and centralized pain. “Fibromyalgia is the poster child for this third category of pain,” Clauw said, according to a news release.
However, disagreement still exists among the medical community about how to name and categorize centralized pain. But Clauw said that clinicians should be focused on evaluating patients individually, instead of categorizing their disease state.
“You find evidence of peripheral pain, you treat that,” Clauw said. “If you find evidence of neuropathic pain, you treat that. Then find the evidence of centralized pain and treat that.”
“Instead of thinking of it as one disease, think about the factors that impact individual patients — sleep disorder, fatigue, various kinds of pain, depression, trouble concentrating,” he added. “It is also important to remember that fibromyalgia may be the tip of the iceberg. These symptoms may indicate something else.”
During his talk, Clauw stressed the over-use of opioids for managing patients’ symptoms. “The body’s natural opioid production system may be impacted in fibromyalgia, so giving them opioids could be fueling the fire,” he said.
According to the researcher, doctors should be paying more attention to centralized pain. He also noted that tricyclic drugs, serotonin and norepinephrine reuptake inhibitors, and gabapentinoids show strong evidence to treat this type of pain.
“Overall, though, we need to use drugs in a more nuanced way,” he said.
In a second talk, Carmen E. Gota, MD, of the Cleveland Clinic, emphasized the importance of exercise and personalized patient care for fibromyalgia. During her presentation, the researcher stressed the importance of non-pharmacologic interventions, in light of the increased use of drugs among patients with fibromyalgia.
“In 2010, about 80 percent of patients were taking analgesic drugs and 52 percent were taking central acting drugs,” Gota said. “Over time, we have seen an increasing use of [central nervous system] CNS drugs. However, despite the increasing use of centrally acting drugs, we do not see a decrease in use of analgesics.”
Gota also emphasized the importance and strong evidence of the effectiveness of other non-pharmacological interventions, including cognitive behavioral and multicomponent therapies, meditation, acupuncture, hydrotherapy, as well as other physical therapy methods to help patients manage their pain.
“In terms of the guidelines, the only one we had a strong recommendation for is exercise,” Gota said. “Exercise has been shown to have consistent impact on a number of domains.”
Gota also underscored the importance of a tailored approach to fibromyalgia, and the need for clinicians to identify unmodifiable and modifiable factors.
“It is important to know your patient, because that will determine how you are going to treat your patient,” she concluded. “Establish a network of collaborators who will help treat your patient, including primary care providers, physical therapists, psychologists or psychiatrists, and sleep medicine experts.”