Fibromyalgia for healthcare providers

Key points about fibromyalgia

  • This page contains information for healthcare providers on fibromyalgia.
  • It includes information about pain and links to diagnostic and clinical resources. 
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From Nicholas M, Vlaeyen JWS, Rief W, Barke A, Aziz Q, Benoliel R et al. The IASP classification of chronic pain for ICD-11 – chronic primary pain(external link) Pain 2019;160(1):28-37.

Fibromyalgia is classified under the ICD-11 as an example of Chronic Primary Pain, sub-type Widespread Pain. It is now considered to include nociplastic pain (see ISAP terminology(external link)) and central sensitization.

Chronic primary pain is defined as pain in one or more anatomical regions that persists or recurs for longer than 3 months is associated with significant emotional distress (eg, anxiety, anger, frustration, or depressed mood) and/or significant functional disability (interference in activities of daily life and participation in social roles), and the symptoms are not better accounted for by another diagnosis.

Specifically, it is chronic pain in one or more anatomical regions that persists or recurs for longer than 3 months and is associated with significant emotional distress and/or significant functional disability. The emotional distress can take many forms, such as demoralization, depressed mood, anxiety, anger, or frustration. Functional disability also covers a wide range of interference in daily life, such as difficulties working, sleeping, or taking part in social activities. In addition to these common features, the individual types of CPP have unique characteristics that distinguish one particular diagnosis from another.

Chronic widespread pain is diffuse musculoskeletal pain in at least 4 of 5 body regions and in at least 3 or more body quadrants (as defined by upper–lower/left–right side of the body) and axial skeleton (neck, back, chest, and abdomen). Chronic widespread pain is characterized by the core features of CPP, such as pain persisting for at least 3 months, and associated with significant emotional distress and/or functional disability. The diagnosis is appropriate if the pain is not directly attributable to a nociceptive process in these regions, and if there are features consistent with nociplastic pain, such as spontaneous or evoked pain in the affected regions, accompanied by allodynia and/or hyperalgesia and identified psychological and social contributors. Chronic widespread pain is often associated with increased medical comorbidity, including sleep disturbances, obesity, hypertension, and diabetes.

In order to explain the mechanisms of fibromyalgia or chronic primary pain to patients, you will need to learn about the modern neuroscientific understanding of pain and how it is produced in the body, especially how persistent pain can be created as a dysfunction of the pain system itself (see reading and websites below).

Within the HealthPathways system (see below), some regions have the following tools available:

  • Widespread Pain Index (WPI)
  • Symptom Severity (SS) scale score
  • Assessment criteria.

Link to page (once logged in) for Auckland region(external link)Canterbury(external link) and 3D Wellington.(external link)

Professional development

Butler DS, Moseley GL. Explain Pain 2nd Ed. (external link) Noigroup Publications, Australia, 2013
Courses in understanding pain for health professionals(external link) Noigroup, Australia

Goodfellow Gem: Stretching, in addition to moderate exercise, is helpful for women with fibromyalgia

In a small randomised trial of 64 women with fibromyalgia, those randomised to ten minutes of moderate-intensity exercise (50 to 70% of age-predicted heart rate) three times per week, plus one 45 minute stretching session had improvements in many outcomes after 12 weeks compared with those who got exercise alone.

The findings included increased sleep quality and a decreased impact of fibromyalgia on the quality of life and reduced pain scores.

The stretching exercises included three repetitions of ten seconds for trunk muscles and two repetitions of ten seconds for extremity muscles. There were 19 types of stretching activities which you can see in the reference.

Gómez-Hernández M, Gallego-Izquierdo T, Martínez-Merinero P, et al. Benefits of adding stretching to a moderate-intensity aerobic exercise programme in women with fibromyalgia – a randomized controlled trial(external link) Clin Rehab. 2020;34(2):242-251

Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust

Reviewed by: Dr Hamish Wilson, Associate Professor, Department of General Practice and Rural Health, University of Otago

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