Fibromyalgia (FMS) as a chronic condition is managed using Medicare chronic disease management care planning/team care arrangements.

Just like diabetes, FMS can be managed in General Practice using a shared care model with the patient being actively involved in the decision making. Self-monitoring is crucial for optimal treatment. Management is individually tailored to each patient and is primarily non-pharmacological, focussing on improved symptoms, function, health outcomes and quality of life.

While spontaneous recovery is unusual, there are subgroups of patients who will have significant benefit from particular therapeutic approaches.

Fibromyalgia symptoms vary in range and intensity over time and between patients.  While some people are very disabled, some can function at a limited level and some are able to work part or full time but have limited activities outside work.

An often forgotten important step is to document the “baseline” and recognise your current limits. This will allow effective monitoring of interventions and treatments and enable you to recognise whether they are helping (see Monitoring).

When trying each new treatment or service, monitoring enables you to link symptom changes (good or bad) to treatments, identifying interactions and adverse outcomes.  It is important to record everything you try (e.g. medications, health products, dietary changes, exercise and stress levels).

Your records will also enable you to rank your treatment priorities with regards to symptoms, function and quality of life towards tailored patient-centred care and optimal outcomes.

Fibromyalgia management requires a team approach. Sustained support and participating in education and skills programs will assist you to become an ‘expert active self-manager’.

This is the most important of all interventions as it enables successful living with this debilitating multidimensional disorder.

General Practitioners are also the gatekeepers to many of the health, welfare (Centrelink and NDIS) and life management issues required by Fibromyalgia patients over many years.

Annual Care Plan

A Fibromyalgia Care Plan funded by Medicare, reviews your progress and uses treatment outcomes to improve management strategies including referrals to appropriate allied health services. It will also include health and wellness coaching and community programs available in your area. They provide ongoing documentation of multi-disciplinary management often necessary for accessing government services.

Management Programs for Centrelink and NDIS assessment requirements need patients to have documentation demonstrating that they are ‘fully stabilised’ and ‘fully managed’. 

Ongoing Management

Monitoring and feedback improves communication. Always take your monitoring records and a list of your medications to appointments. Include both prescribed and non-prescribed including nutritional products.

Discuss each symptom with your health care practitioner. This is particularly important for any new symptoms or symptom changes. Managing your illness involves balancing a combination of pharmaceuticals, natural remedies, self-management strategies and lifestyle adjustments.

Improving Sleep

Managing sleep is important, even small improvements in sleep will help. Try to find techniques that will improve sleep time and quality. Establish a routine; create a quiet environment; avoid getting overtired; try herbal remedies. Many find it helpful to take medication to assist sleep. If sleep is an issue ask for a referral to a sleep specialist.

Pain Management/Lifestyle Adjustments

Pain management is multi-faceted and includes physiotherapy, gentle exercise and other therapies.

Alternative therapies such as acupuncture, massage and hydrotherapy can be helpful for some but their effectiveness varies amongst individuals. Consider including a naturopathic doctor as part of your health care team.

Medications are a last resort. Talk to your doctor. A few drugs have been approved specifically for Fibromyalgia. Many medications are trial and error so be patient. People with Fibromyalgia are often sensitive to medications and it may be necessary to start with a lower than recommended dose and increase gradually, monitoring the effects carefully. This is referred to as the “start low, go slow” principle.

As each individual responds differently to medications, your doctor may suggest other medications not specifically designed for Fibromyalgia. Don’t forget to keep your monitoring records so you can provide important input to your doctor for treatment decisions.

Exercise

Many studies have shown that exercise is effective in improving some symptoms. However, you should approach exercise with caution. Begin slowly and be careful not to aggravate your symptoms.

You will find that you don’t have the same capacity for activity as you once did. It is essential that you manage your energy levels. You will need to pace your activities so that you can be as active as you are able without aggravating your symptoms.

Listen to your body and respect what it is telling you. Plan ahead, know your limits, stop before you reach them. Do not push yourself.

Managing your illness will require lifestyle adjustments. You may need to reduce your daily activities but over time you will accomplish more with less pain.

Nutrition

It can be difficult to prepare meals when dealing with limited energy but a good balanced diet is essential. Do not forget to eat as your body needs fuel to function. Many FMS patients suffer from food sensitivities. Keeping a food diary can be helpful to link symptom changes with food. People often get symptom relief when they eliminate offending foods from their diet. Do not change your diet suddenly without seeking advice. The right diet for you will require trial and error to find which foods bother you. Some common sensitivities include wheat, dairy, corn and refined sugar.

Mind and Body

As in any illness, it is important to understand there is a connection between the mind and the body.

While they will not cure fibromyalgia, many therapies help to reduce stress, promote relaxation, generate positive thinking and help gain a sense of control. Before starting any therapy ensure your therapist fully understands that fibromyalgia is real and serious and that they are using a collaborative approach.

Beneficial activities include meditation, breathing exercises and restorative yoga or from therapeutic activities such as writing and art.

Get Support

One of the biggest challenges people with FMS face is isolation and a lack of understanding from friends, family and even the medical community. It is important to maintain contacts or build new ones.

Look for and join a support group in your area or online e.g. bridgesandpathways.org.au and arthritissa.org.au