How2Torial™ - Best Practices in Fibromyalgia: Individualized Assessment
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Jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications, LLC.
This activity is supported by an educational grant from Pfizer Inc.
This educational activity will allow clinicians to acquire a more in-depth understanding of the evidence-based recommendations and guidelines for the individualized assessment and treatment of fibromyalgia. This knowledge will help clinicians find a more practical expression of guidelines for their patient populations and integrate evidence-based best practices with the clinical expertise of program faculty.
At the completion of this activity, participants should be better prepared to:
- Incorporate evidence of fibromyalgia pathogenesis into comprehensive assessment and management plans
- Discuss the relative merits of various diagnostic approaches for fibromyalgia and assimilate preferred strategies into practice
- Explain the biochemical and clinical rationales for and against various pharmacologic agents for the treatment of fibromyalgia
Statement of Need
Fibromyalgia is a multidimensional, chronic, and heterogeneous pain condition.1 As a relatively common condition, fibromyalgia is associated with significant functional impairment and disability, imposing hardship on patients, families, and society.2,3 Recent scientific findings about the etiology and pathophysiology of fibromyalgia have important implications for clinical practice.3,4 The emerging evidence and expert insights have been translated into structured assessment approaches and simplified diagnostic criteria that incorporate the range of problematic symptom domains—for example, widespread pain, cognitive symptoms, unrefreshing sleep, fatigue, and other somatic symptoms.5,6 Prompt diagnosis is critical to initiate appropriate care, reduce healthcare utilization, and improve patient satisfaction.7-9 Importantly, fibromyalgia is no longer considered a diagnosis of exclusion. Instead, it should be proactively considered and reviewed with other conditions that cause widespread pain. Clinicians may be challenged, however, by medical and psychiatric comorbidities that frequently complicate fibromyalgia diagnosis and management.10,11 Moreover, patients require individualized multimodal and often multidisciplinary treatment strategies to address wide-ranging symptoms and maximize functional outcomes.12,13 As best practices in fibromyalgia assessment and management quickly evolve, clinicians benefit from updates on practical and evidence-based approaches to evaluate symptom burden and translate findings into therapeutic plans.
Fibromyalgia requires multidimensional assessment based in part on signs and symptoms of enhanced sensory processing.6,14 Diagnostic criteria from the American College of Rheumatology have been updated to emphasize the full range of fibromyalgia symptoms.6 These changes, however, place a significant burden on practitioners to complete a full patient interview and comprehensively evaluate the biopsychosocial effects of the disease.13,15 Yet assessing patients presenting with the multifaceted and subjective symptomatology of fibromyalgia is daunting for time-pressed clinicians. Additionally, clinicians require guidance on how to target underlying pathophysiologic processes and tailor treatment regimens based on published evidence and presenting symptoms in each patient. This series of Web-based tutorials integrates insights from specialists in rheumatology and pain management to facilitate prompt identification of affected patients and help practicing clinicians construct comprehensive, long-term management plans.
1. Clauw DJ. Fibromyalgia: an overview. Am J Med. 2009;122(suppl):S3-S13.
2. Solitar BM. Fibromyalgia: knowns, unknowns, and current treatment. Bull NYU Hosp Jt Dis. 2010;68:157-161.
3. Culpepper L. Recognizing and diagnosing fibromyalgia. J Clin Psychiatry. 2010;71:e30.
4. Russell IJ, Larson AA. Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheum Dis Clin North Am. 2009;35:421-435.
5. Williams DA, Schilling S. Advances in the assessment of fibromyalgia. Rheum Dis Clin North Am. 2009;35:339-357.
6. Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62:600-610.
7. White KP, Nielson WR, Harth M, Ostbye T, Speechley M. Does the label "fibromyalgia" alter health status, function, and health service utilization? A prospective, within-group comparison in a community cohort of adults with chronic widespread pain. Arthritis Rheum. 2002;47:260-265.
8. Hughes G, Martinez C, Myon E, Taieb C, Wessely S. The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: an observational study based on clinical practice. Arthritis Rheum. 2006;54:177-183.
9. Choy E, Perrot S, Leon T, et al. A patient survey of the impact of fibromyalgia and the journey to diagnosis. BMC Health Serv Res. 2010;10:102.
10. Choy EH, Mease PJ. Key symptom domains to be assessed in fibromyalgia (outcome measures in rheumatoid arthritis clinical trials). Rheum Dis Clin North Am. 2009;35:329-337.
11. McCarberg BH. Clinical overview of fibromyalgia. Am J Ther. 2011 [Epub ahead of print].
12. Goldenberg DL. Multidisciplinary modalities in the treatment of fibromyalgia. J Clin Psychiatry. 2008;69(suppl 2):30-34.
13. Hassett AL, Gevirtz RN. Nonpharmacologic treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine. Rheum Dis Clin North Am. 2009;35:393-407.
14. Petersel DL, Dror V, Cheung R. Central amplification and fibromyalgia: disorder of pain processing. J Neurosci Res. 2011;89:29-34.
15. Goldenberg DL, Clauw D, Fitzcharles M, et al. How to use the new ACR fibromyalgia diagnostic criteria. Arthritis Care Res (Hoboken). 2011.
Peter Barland, MD
Professor Emeritus, Department of Medicine (Rheumatology)
Professor Emeritus, Department of Pathology
Albert Einstein College of Medicine
Bronx, New York
This activity is intended for primary care physicians and other healthcare professionals who treat patients with fibromyalgia.
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Albert Einstein College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period of July 18, 2011 to July 17, 2012, participants must (1) read the learning objectives and disclosure statements, (2) complete the Pre-activity Questionnaire (3) participate in the educational activity, (4) complete the Posttest (Post-activity Questionnaire), (5) click on “Get Credit” to complete the Evaluation and request credit. A score of at least 70% is required to successfully complete this activity.
Conflict of Interest Statement
The Conflict of Interest Disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Presenters whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to present.
Albert Einstein College of Medicine also requires that faculty participating in any CME activity and anyone in a position to influence content disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for use in the United States.
Faculty & Planning Committee Disclosures
Ronald J. Rapoport, MD, FACR
Abbott Laboratories (Speaker’s Bureau); Amgen Inc. (Speaker’s Bureau); Covidien AG (Consultant, Speaker’s Bureau); Forest Laboratories, Inc. (Speaker’s Bureau); Lilly USA, LLC (Speaker’s Bureau); Pfizer Inc (Speaker’s Bureau).
Peter Barland, MD, has no relevant financial relationships to disclose.
Steven Jay Feld of Albert Einstein College of Medicine, or a member of his household, owns securities in Bioheart, Inc.; Chelsea Therapeutics, Inc.; and Pharmacopeia, Inc.
Poshala Aluwihare, PhD, of Asante Communications has no relevant financial relationships to disclose.
The opinions, ideas, recommendations, and perspectives expressed in this program and accompanying materials are those of the presenting faculty only and do not necessarily reflect the opinions, ideas, recommendations, or perspectives of their affiliated institutions, Albert Einstein College of Medicine, Montefiore Medical Center, Asante Communications, or the activity’s commercial supporters.
Copyright © 2011 Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications, LLC. All rights reserved. No part of this program may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.