Should Rheumatologists Retain Ownership of Fibromyalgia?

Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada. .
The Journal of Rheumatology (Impact Factor: 3.19). 05/2009; 36(4):667-70. DOI: 10.3899/jrheum.081073
Source: PubMed
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    • ". Family physicians are likely best suited for the care of these patients in view of the multiplicity of complaints and need for therapies that span many categories [16]. It is also questionable whether there is truly a need for the diagnosis to be confirmed by a medical specialist such as a rheumatologist. "
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    ABSTRACT: Fibromyalgia (FMS) is a valid clinical condition that affects 2%-4% of the population with a pivot symptom of widespread body pain. The cause and cure of FMS are as yet unknown. The concept of FMS has evolved over the past two decades to incorporate symptoms beyond pain as contributing to the global spectrum of suffering. FMS is now recognized to be grounded in the neurological domain with evidence of dysregulation of pain processing. Appreciation of the neurophysiologic mechanisms operative in FMS has contributed to rational treatment recommendations, although a "gold standard treatment" does not currently exist. Ideal treatments for FMS patients should be individualized with emphasis on active patient participation, good health practices, and multimodal intervention, incorporating nonpharmacologic and pharmacologic treatments. Predictors of outcome, which is favourable in over 50% of patients, are unknown, but those with better outcome do more physical activity and use fewer medications.
    Pain Research and Treatment 01/2012; 2012(2090-1542):184835. DOI:10.1155/2012/184835
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    ABSTRACT: <⁄span> Recent neurophysiological evidence attests to the validity of fibromyalgia (FM), a chronic pain condition that affects >2% of the population. <⁄span> To present the evidence-based guidelines for the diagnosis, management and patient trajectory of individuals with FM. <⁄span> A needs assessment following consultation with diverse health care professionals identified questions pertinent to various aspects of FM. A literature search identified the evidence available to address these questions; evidence was graded according to the standards of the Oxford Centre for Evidence-Based Medicine. Drafted recommendations were appraised by an advisory panel to reflect meaningful clinical practice. <⁄span> The present recommendations incorporate the new clinical concepts of FM as a clinical construct without any defining physical abnormality or biological marker, characterized by fluctuating, diffuse body pain and the frequent symptoms of sleep disturbance, fatigue, mood and cognitive changes. In the absence of a defining cause or cure, treatment objectives should be patient-tailored and symptom-based, aimed at reducing global complaints and enhancing function. Healthy lifestyle practices with active patient participation in health care forms the cornerstone of care. Multimodal management may include nonpharmacological and pharmacological strategies, although it must be acknowledged that pharmacological treatments provide only modest benefit. Maintenance of function and retention in the workforce is encouraged. <⁄span> The new Canadian guidelines for the treatment of FM should provide health professionals with confidence in the complete care of these patients and improve clinical outcomes.
    05/2013; 18(3):119-26.

  • Annales d Endocrinologie 10/2006; 67(5):422-422. DOI:10.1016/S0003-4266(06)72710-X · 0.87 Impact Factor
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