The fight against fibromyalgia

As seen in the December issue of Retail Pharmacy magazine. 

Fibromyalgia is a common, chronic condition in which people experience pain and stiffness in various parts of the body, fatigue and sleeplessness.¹ The condition, experienced by up to five in 100 people, disproportionately affects young to middle-aged women.

Symptoms 

The usual symptoms of fibromyalgia include muscular and bone pain that gives a sense of deep ache or burning. This can be exacerbated through movement or stress. Those with the condition may be more sensitive to pain, and have difficulty getting to sleep and staying asleep. They may also experience long periods of muscle and/or bone stiffness or tenderness lasting a few months at a minimum.¹

Symptoms reported but not as uniformly experienced are problems with memory and focus, anxiety and depression, headaches, numbness or tingling in the limbs, and irritable bowel syndrome.¹ 

Cause and diagnosis 

With no definitive explanation for the onset of fibromyalgia, nor a single test or examination that can diagnose it, patients who present with symptoms of fibromyalgia will most likely undergo blood tests and X-rays at the request of their doctor to investigate sources of their muscle or bone pain.¹

So, it’s more likely to be diagnosed once any other condition or cause has been ruled out. It’s considered a neural disorder in which the brain reacts with heightened sensitivity and an abnormal pain response. 

Management 

A holistic approach to the management of fibromyalgia is one that primarily involves the patient. Rather than being told what to do, and how, it’s important for the pharmacist, doctor or specialist they consult to educate and encourage self-observation and education as a means of empowerment.

A GP can monitor the symptoms and provide prescriptions or request tests and examinations as deemed necessary, while other experts, including physiotherapists, personal trainers, psychologists or rheumatologists, may be part of a treatment approach. Since fibromyalgia symptoms are prone to change over time, and in varying conditions (ie, when the person is under greater stress, their movement patterns change) it’s likely that the team of support will alter temporarily, or over the longer term, too.¹

Psychologists can assist with the management of stress and anxiety, or in implementing cognitive behaviour therapy measures as a means of addressing physical pain and addressing habitual reactions. They may also play a role in addressing sleep habits, such as having a routine around the time of sleep and waking.

Paracetamol and NSAIDs can provide temporary relief. According to the Australian government’s Healthdirect site, pregabalin² and gabapentin³, which are usually prescribed for epilepsy, have proved promising in pain reduction. However, neither pregabalin nor gabapentin is listed on the PBS for fibromyalgia, so if they’re prescribed for this condition, they may be expensive for some.

The Fibromyalgia Support Network⁴ advises that a healthy, balanced diet can prevent the common experience of irritable bowel syndrome, and recommends the low-FODMAP diet.⁵

Antidepressants (SSRIs and tricyclic antidepressants) have proven to be effective to an extent, but studies are not definitive and their benefits only modest in trials.^{6<superscript>} 

Role of community pharmacists 

Community pharmacists can provide compassionate support to their customers presenting with fibromyalgia.

It’s important to remember that despite the cause of the condition being unclear, the experience of pain is real and often distressing for sufferers.

The priority for pharmacists is to listen, advise and recommend where invited.

Pharmacists can also provide referrals to support groups, including Australia’s Fibromyalgia Support Network, which offers educational workshops and social events for members.⁷

There is little evidence for alternative medicines being effective, although strength training has proven to assist in the experience of pain and sleeplessness.⁶

Pharmacists can reassure customers with fibromyalgia, or symptoms that indicate fibromyalgia, that a multidisciplinary and holistic approach to management can alleviate the severity of their symptoms.

It’s important to emphasise management over-focus on a cure since there is no evidence that fibromyalgia can be cured.⁶

References

1. Healthdirect. ‘Fibromyalgia’. healthdirect.gov.au/fibromyalgia
2. ‘Active ingredient: pregabalin’. healthdirect.gov.au/medicines/medicinal-product/aht,20887/pregabalin
3. ‘Active ingredient: gabapentin’. healthdirect.gov.au/medicines/medicinal-product/aht,21352/gabapentin
4. Fibromyalgia Support Network. ‘Nutrition’. fibronetwork.org.au/nutrition/
5. Monash University. ‘Starting the FODMAP diet: What to expect from the 3-step FODMAP diet’. monashfodmap.com/ibs-central/i-have-ibs/starting-the-low-fodmap-diet/
6. US Pharmacist. ‘Fibromyalgia syndrome: An update for pharmacists’. com/article/fibromyalgia-syndrome-an-update-for-pharmacists
7. Fibromyalgia Support Network. ‘About the Network’. fibronetwork.org.au/

This feature was originally published in the December issue of Retail Pharmacy magazine.