13Oct, 2024
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Prevalence, Diagnosis, and Management of Fibromyalgia in Musculoskeletal Practice

Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and other symptoms, affecting a significant portion of the population. It presents a diagnostic challenge due to its overlapping features with other disorders. This article reviews the prevalence of fibromyalgia in clinical practice, the diagnostic criteria, differential diagnoses, relevant tests, and how patients with fibromyalgia may benefit from musculoskeletal therapy.

Prevalence of Fibromyalgia

Fibromyalgia affects approximately 2-8% of the global population, with variations depending on geographic location and population demographics (Queiroz, 2013). In the UK, the prevalence is estimated at 2.9%, with women being more commonly affected than men (Heidari et al., 2017). The condition is more prevalent in middle-aged individuals, with a peak incidence between the ages of 40 and 60 (Clauw, 2014). Musculoskeletal practitioners are likely to encounter fibromyalgia patients frequently due to the chronic pain and fatigue that drive these patients to seek care.

Diagnosis of Fibromyalgia

Diagnosing fibromyalgia can be challenging, as it is a clinical diagnosis primarily based on patient history and symptomatology. The 2016 revised criteria by the American College of Rheumatology (ACR) are widely used and include the following components:

  1. Widespread Pain Index (WPI): Patients report pain in multiple body areas, scored from 0-19.
  2. Symptom Severity Scale (SSS): Evaluates fatigue, unrefreshing sleep, cognitive symptoms, and other somatic complaints.
  3. Duration of Symptoms: Symptoms should persist for at least three months.
  4. Exclusion of Other Conditions: No other disorder should better explain the symptoms (Wolfe et al., 2016).

Unlike previous criteria, the 2016 guidelines do not require tender point examination but focus on widespread pain and associated symptoms like fatigue, cognitive dysfunction, and sleep disturbances.

Differential Diagnoses

Given the overlap of symptoms with other conditions, several differential diagnoses should be considered, including:

  • Rheumatoid arthritis: Chronic joint inflammation with joint deformities, detected via blood tests such as rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA).
  • Systemic lupus erythematosus (SLE): An autoimmune disorder affecting multiple organ systems, diagnosed with antinuclear antibody (ANA) testing.
  • Chronic fatigue syndrome (CFS): Shares similar symptoms but is distinguished by the predominant feature of post-exertional malaise.
  • Hypothyroidism: Can present with fatigue, muscle pain, and cognitive difficulties, diagnosed through thyroid function tests (TSH and free T4).
  • Depression and anxiety disorders: Psychological assessments are necessary as these conditions can mimic fibromyalgia symptoms or coexist with them (Macfarlane et al., 2017).

Tests for Fibromyalgia

While there is no specific diagnostic test for fibromyalgia, laboratory tests are essential to rule out other conditions. Common tests include:

  • Complete blood count (CBC): To rule out anemia or infection.
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): To rule out inflammatory conditions.
  • Thyroid function tests: To assess for hypothyroidism.
  • Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA): To exclude rheumatoid arthritis.
  • Antinuclear antibody (ANA) test: To screen for autoimmune conditions like lupus (Häuser & Fitzcharles, 2018).

Benefits of Musculoskeletal Therapy for Fibromyalgia Patients

Fibromyalgia patients often experience benefits from a multidisciplinary approach to pain management, including musculoskeletal therapies. These therapies can help alleviate pain, improve mobility, and enhance the overall quality of life.

  1. Exercise Therapy: Aerobic and strength training exercises are among the most effective treatments for fibromyalgia. A systematic review by Bidonde et al. (2017) concluded that exercise significantly reduces pain and improves physical function and well-being in fibromyalgia patients. Low-impact activities such as swimming, walking, and cycling are particularly beneficial.
  2. Manual Therapy: Techniques such as myofascial release, trigger point therapy, and gentle spinal manipulation can provide relief from muscle tension and pain. Studies suggest that manual therapies can reduce muscle stiffness and improve range of motion in fibromyalgia patients (Kalichman et al., 2010).
  3. Cognitive Behavioral Therapy (CBT): While not a musculoskeletal therapy, CBT is commonly integrated with physical therapies. It helps patients manage the emotional and psychological aspects of chronic pain, leading to improved outcomes when combined with physical treatments (Bernardy et al., 2018).
  4. Acupuncture: Some patients report symptom relief from acupuncture. A meta-analysis by Deare et al. (2013) found moderate evidence supporting acupuncture for improving pain and fatigue in fibromyalgia patients, although more research is needed.
  5. Massage Therapy: Regular massage therapy has been shown to reduce pain, anxiety, and depression while promoting relaxation in fibromyalgia patients. A meta-analysis by Yuan et al. (2015) demonstrated that massage therapy could reduce pain intensity and improve sleep quality in fibromyalgia.

Conclusion

Fibromyalgia is a common condition in musculoskeletal practice, and its diagnosis requires a thorough assessment of symptoms, careful exclusion of other conditions, and patient-centered care. Musculoskeletal therapies, including exercise, manual therapy, and integrative approaches like acupuncture, play a vital role in improving the quality of life for fibromyalgia patients. A tailored, multidisciplinary approach is most effective in managing the complex symptoms of this chronic disorder.

References

Bernardy, K., Füber, N., Köllner, V., & Häuser, W. (2018). Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome—A systematic review and metaanalysis of randomized controlled trials. The Journal of Rheumatology, 45(6), 786-794.

Bidonde, J., Busch, A. J., Schachter, C. L., Overend, T. J., Kim, S. Y., Góes, S. M., & Boden, C. (2017). Aerobic exercise training for adults with fibromyalgia. Cochrane Database of Systematic Reviews, (6), CD012700.

Clauw, D. J. (2014). Fibromyalgia: A clinical review. JAMA, 311(15), 1547-1555.

Deare, J. C., Zheng, Z., Xue, C. C., Liu, J. P., Shang, J., Scott, S. W., & Littlejohn, G. (2013). Acupuncture for treating fibromyalgia. Cochrane Database of Systematic Reviews, (5), CD007070.

Heidari, F., Afshari, M., & Moosazadeh, M. (2017). Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatology International, 37(9), 1527-1539.

Häuser, W., & Fitzcharles, M. A. (2018). Facts and myths pertaining to fibromyalgia. Dialogues in Clinical Neuroscience, 20(1), 53-62.

Kalichman, L., & Medvigy, A. (2010). Myofascial release for the treatment of fibromyalgia: A systematic review. Journal of Bodywork and Movement Therapies, 14(1), 73-78.

Macfarlane, G. J., Kronisch, C., Dean, L. E., Atzeni, F., Häuser, W., Fluß, E., … & Jones, G. T. (2017). EULAR revised recommendations for the management of fibromyalgia. Annals of the Rheumatic Diseases, 76(2), 318-328.

Queiroz, L. P. (2013). Worldwide epidemiology of fibromyalgia. Current Pain and Headache Reports, 17(8), 356.

Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Häuser, W., Katz, R. S., … & Walitt, B. (2016). 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Seminars in Arthritis and Rheumatism, 46(3), 319-329.

Yuan, S. L. K., Matsutani, L. A., Marques, A. P. (2015). Effectiveness of different styles of massage therapy in fibromyalgia: A systematic review and meta-analysis. Manual Therapy, 20(2), 257-264.