Fibromyalgia (FMS) is a complex multisystem physical disorder, a primary chronic pain condition (classified in the WHO International Classification of Diseases: ICD-11 Version: 2019).

The ongoing widespread body pain is complex. It varies in different people but can involve the muscles, ligaments, tendons and surrounding structures without any obvious tissue damage. Understanding the types of pain is important when choosing pain management strategies.

Fibromyalgia patients can be sensitive to touch (allodynia), making normal contact or pressing some areas of the body cause great degrees of discomfort and pain.  

Factors that aggravate pain in Fibromyalgia

• Persistent peripheral pain generators (spinal and/or peripheral arthritis, tendinopathies and myofascial trigger points)
• Sleep disorders (obstructive sleep apnoea)
• Restless legs and periodic limb movement disorder
• Obesity (with consequent pain-sensitising effects of meta-inflammation)
• Smoking
• Opioid-induced hyperalgesia
• Statin myopathy
• Depression
• Catastrophising cognitive style
• Psychosocial stressors

There are additional clinical symptoms & signs that can contribute importantly to the patient’s burden of illness.

• Neurological Manifestations: Numbness and tingling in the muscles, cramps, muscle weakness, headaches, generalized weakness, sensitivity to light and sound.
• Neurocognitive Manifestations: Poor concentration and short-term memory loss, impaired speed of performance, inability to multi-task, and/or cognitive overload
• Sleep Dysfunction: Sleep is unrefreshing. There may be disturbance in sleep quantity or rhythm including daytime hypersomnia or night time insomnia.
• Fatigue: There is persistent and reactive fatigue accompanied by reduced physical and mental stamina.
• Autonomic and/or Neuroendocrine Manifestations: irregular heartbeat, dizziness, heat/cold intolerance, respiratory disturbances, intestinal and bladder disturbances, stress intolerance, blunted emotions and/or reactive depression
• Stiffness: It is common to have generalized or regional stiffness that is most severe upon awakening and typically lasts for hours. Stiffness can return during periods of inactivity during the day.

Symptom Levels vary

Fibromyalgia is a spectrum disorder with regard to pain and fatigue levels. Symptoms vary in range and intensity over time and between patients.

While some patients are very disabled, some can function at a limited level. Others are able to work part or full time, however have limited activities outside work.

For a comprehensive list of symptoms, grouped according to body systems, see Patient Leaflet 3 Fibromyalgia Canadian Multisystem Questionnaire.

This is a useful recording sheet to fill out and take with you to your appointments.  It will also guide treatment priorities, and assist you with your monitoring and recording your symptom changes and fluctuations.

Unique Circumstances – Tailored Health Care 

Patient Leaflet 3 Fibromyalgia Canadian Multisystem Questionnaire is useful as you work with your health care team towards an accurate diagnosis and setting up an optimal management and care plan.  Over time your care can be tailored and adjusted by ongoing feedback because the symptom levels of individual patients will respond to different treatments.

Fibromyalgia Management is multi-disciplinary

FMS management requires a mixture of medical, pharmacological, non-pharmacological and life style interventions.  Management also includes a range of providers such as physiotherapists, exercise physiologists, dietitians, community pain programs, psychologists, also wellness providers and education and lifestyle programs.

General Practice Clinics are pivotal in management as they are the gate keepers of many health welfare and community services you may need over time.

Under Australian Medicare, services are coordinated through General Practice clinics, using Chronic Disease Care Planning and team care arrangements.  These plans enable patients with chronic conditions to access a range of allied health services. Community education programs and health coaching are available to help you better understand your condition, gain new skills and to empower yourself to work in partnership with your health care team.

Care plans are reviewed regularly which enable you to have documentation of your fibromyalgia management/interventions over time.

The Importance of Monitoring and Recording

Monitoring and recording symptoms to provide accurate feedback is crucial because of the changing pattern of each person’s Fibromyalgia symptoms and how treatments and activities affect you. Management is tailored, building on feedback towards an optimal care plan that reflects your priorities.

You can provide important input into how your care is managed and your treatment goals can be aligned with your particular life circumstances and priorities. 

An often forgotten but very important step in management is to get to know your “baseline” and current limits so you can effectively monitor interventions and treatments and recognise whether they are helping.