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Fibromyalgia Syndrome (FMS)

Fibromyalgia Syndrome (FMS)

FMS is best managed in primary care; secondary care interventions, including pain team referral, have been shown to have limited benefit.  There is currently no secondary care commissioned service for patients with fibromyalgia in Cornwall

Referrals for fibromyalgia meeting diagnostic criteria will be rejected

General points

FMS has recently been re-defined for primary care here

Referral Criteria

  • Unexplained, widespread pain in a patient who does not meet diagnostic criteria for FMS
  • Referrals without documented ACR scores, (as below), will be cancelled

Please do not refer patients meeting the criteria for FMS with a positive ANA, without additional clinical indicators of connective tissue diease.

. A positive ANA is a common finding in FMS and does not indicate additional pathology.

 

Diagnosis

Diagnosis is clinical and is based on the American College of Rheumatology, (ACR),  scoring system, below.

 

Symptoms must be;

1)      Present for 3 months or more

AND

2)      Widespread Pain Index 7 or more, with Symptom Severity 5 or more

          Or Widespread Pain Index 3 or more, with Symptom Severity 9 or more

 

AND

 

3)      Have no alternative explanation

All 3 criteria are required for a diagnosis to be made

 

Investigations

Are usually negative; directed at excluding other conditions.

Consider FBC, TFT, ESR, CRP, Vitamin D

RhF and ANA not recommended due to high rate of false positive results

 

 

Treatment

Non-pharmacological treatments

  • promote exercise and avoid social withdrawal
  • treat psychological symptoms if prominent e.g. counselling / CBT
  • use the fit note for any necessary workplace adaptations
  • advice on sleep hygiene, warm baths and physical therapies e.g. yoga, t’ai chi 
  • explain FMS is a disorder of pain processing and direct to self-help resources

Pharmacological treatments with an evidence base

  • TCAs (amitriptyline)
  • SNRIs (duloxetine)
  • Gabapentin / pregabalin

 

 strong opioids or steroids are not recommended