The Controversies and Points of Debate that Remain a Challenge for Fibromyalgia Care Poster presented by Mary-Ann Fitzcharles, ChB, MD

During the creation of the Canadian guidelines for care of FM patients, debate was generated on a number of emphasized clinical issues. Relative to those concerns, the background and purpose of this study centered on fibromyalgia (FM) continuing to present challenges for the health care community with perceptions of diseases and attitudes of physicians being extremely diverse. This report was developed to examine these contentious issues in order to provide accurate information regarding challenges surrounding FM.
The five main areas of controversy were:
  1. Criteria for diagnosis: The contention was that the healthcare community remains fixated on application of diagnostic criteria, the absence of which causes uncertainty. An agreement was reached to recommend that the 2010 ACR criteria may be used to validate a clinical diagnosis, and use of a tender point count may be done by choice; but neither is required for diagnosis.
  2. Treatments: Complimentary and alternative medicine (CAM) therapies were initially discouraged due to a lack of evidence showing efficacy. This conclusion was altered to emphasize a lack of evidence to support CAM use in the treatment of FM, thereby allowing for individual choice. Antidepressants in all classes have shown some efficacy, individual bias favored the newer serotonin norepinephrine reuptake inhibitors. Resolution was achieved by recommending that the specific choice be tailored to the patient according to physicians’ knowledge and evidence for efficacy.
  3. Terminology: The idea to change the terminology of antidepressants and anticonvulsants to pain modulators was discarded in favor of promoting these medications as pain modulators.
  4. Past/triggering events: FM causation is contentious with the experts recommending acknowledgement of previous negative lifetime events, but without excessive emphasis on their importance.
  5. Work and disability: A recommendation was made to keep patients in the workforce, which was softened to state that continued work is ideal, with application of a rehabilitation program to improve function and possible return to work. 
The conclusion of this report challenged the healthcare community to adopt a rational and unified approach to FM management in order to dispel false information that obstructs management. The profusion of anecdotal literature, strong advocacy from various groups and the subjective nature of FM symptoms may all have played a part in diagnosis and treatment uncertainty. These guidelines were created to reflect the available evidence with clinically applicable input from health care workers from various disciplines and adhere to strict standard of development. Continued dialogue will help dispel misperceptions and facilitate optimal patient care.