Challenges of implementing fibromyalgia treatment guidelines in current clinical practice

ABSTRACT

The current diagnostic and treatment pathway for patients with fibromyalgia (FM) is lengthy, complex, and characterized by multiple physician visits with an average 2-year wait until diagnosis. It is clear that effective identification and appropriate treatment of FM remain a challenge in current clinical practice. Ideally, FM management involves a multidisciplinary approach with the preferable patient pathway originating in primary care but supported by a range of health care providers, including referral to specialist care when necessary. After the publication of individual clinical studies, high-quality reviews, and meta-analyses, recently published FM treatment guidelines have transitioned from an expert consensus to an evidence-based approach. Evidence-based guidelines provide a framework for ensuring early diagnosis and timely adoption of appropriate treatment. However, for successful outcomes, FM treatments must adopt a more holistic approach, which addresses more than just pain. Impact on the associated symptoms of fatigue and cognitive problems, sleep and mood disturbances, and lowered functional status are also important in judging the success of FM therapy. Recently published guidelines recommend the adoption of a symptom-based approach to guide pharmacologic treatment. Emerging treatment options for FM may be best differentiated on the basis of their effect on comorbid symptoms that are often associated with pain (e.g. sleep disturbance, mood, fatigue). The current review discusses the most recently published Canadian guidelines and the implications of the recent European League Against Rheumatism (EULAR) recommendations, with a focus on the challenges of implementing these guidelines in current clinical practice.

KEYWORDS:

• Fibromyalgia
• treatment guidelines
• clinical practice
• pharmacotherapy
• pain management

Acknowledgments

Editorial assistance was provided by Anna Battershill, MSc; and Nick Watson, PhD, of ApotheCom (Yardley, PA); and Claire Daniele, PhD, of AlphaBioCom, LLC (King of Prussia, PA), and was funded by Daiichi Sankyo, Inc. (Basking Ridge, NJ).

Declaration of interest

The funding for this article was provided by Daiichi Sankyo, Inc.; however, company personnel had no role in article design, manuscript preparation, or publication decisions. The authors did not receive remuneration for the writing of this manuscript. LM Arnold has received research funding from Eli Lilly, Pfizer, Tonix, Allergan, Astellas, Aptinyx, Cefaly, and Daiichi Sankyo; and has acted as a consultant for Pfizer, Astellas, Daiichi Sankyo, and Innovative Med Concepts. LM Arnold has also been a speaker for Pfizer. DJ Clauw has acted as a consultant for Abbott, Cerephex, Eli Lilly, Forest Labs, Johnson & Johnson, Merck, Pfizer, Samumed, Theravance, Tonix, UCB, and Zynerba; and has acted on the Advisory Boards of Astellas and Purdue Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

The funding for this article was provided by Daiichi Sankyo, Inc. (Basking Ridge, NJ).