General practitioners are pivotal in seamless co-ordinated multidisciplinary management of Fibromyalgia. Management is individually tailored and is primarily non-pharmacological, focussing on improved symptoms, function, health outcomes and quality of life.

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.

• Use GP Chronic Disease Management Care Plan and Team Care Items

• GP Management see
  • Fibromyalgia Diagnosis and Management at HealthPathways South Australia Information for GPs or login page
  • Bridges and Pathways Institute

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

Fibromyalgia management plans include:

1. Confirmation of diagnosis and supportive clinical care
2. Information about fibromyalgia and management including the range of interventions that can benefit the patient
3. An individually tailored treatment program that best meets the needs of the patient
4. Education about fibromyalgia: 
   • The importance of monitoring and feedback communications
   • Avoiding push through and ‘pain wind-up’
   • Sleep and sleep hygiene and the role of sleep disorders in pain wind-up
   • Pain management and the difference between acute and chronic pain
   • Maintaining movement
   • Any other relevant symptoms
   • The influence of lifestyle choices
5. Regular supportive general practice care monitoring treatment outcomes and patient feedback
   • Include referrals to appropriate allied health professionals who understand individually tailored programs for movement and pain management.
   • For best outcomes from referrals ensure adequate analgesia.
   • Review the role of stress and mood disorders
     • Encourage patient to learn simple relaxation techniques, to consider formal stress reduction programs, meditation or mindfulness
     • Emphasise self-management and coping skills

6. Link patient to fibromyalgia aware community groups for information and wellness activities e.g. Bridges and Pathways. Community services vary according to postcodes and local government.

Ongoing Management

Many Fibromyalgia patients have overlapping, co-existing or aggravating conditions. For this reason, there needs to be ongoing clinical evaluation and management of disorders which can aggravate neurophysiological balance.

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
• Psychosocial stressors

Treat any other areas e.g.

• Sleep conditions
• Mood disorders
• Gastrointestinal conditions; irritable bowel, food allergies
• Other Chronic pain conditions
  • Chronic Fatigue Syndrome
  • Tension headaches and migraines
  • Temporomandibular disorders
  • Pelvic Pain
  • Vulvodynia
  • Endometriosis
  • Interstitial cystitis
  • Other musculoskeletal conditions

Referrals

Consider referral to:

1. Exercise Physiologist for functional assessment and tailored exercise program
2. Physiotherapist for functional biomechanical assessment and pain management. Physiotherapist needs to be skilled in myofascial release and other pain management techniques
3. Dietician to review nutritional and dietary approach
4. Occupational therapist for activities of daily living and functional occupational therapy assessment
5. Psychologist specialising in adjustment to living with complex chronic condition (mental health care plan), others may require management of often unrecognised cognitive dysfunction associated with Fibromyalgia
6. Other allied health referrals are required for affordable ongoing support and maintenance of lifestyle e.g. hydrotherapy, stress management
7. Community programs
   1. Sustained support and education and skills programs assist patients to become ‘expert active self-managers’. This is the most important of all interventions to enable successful living with this debilitating multidimensional disorder
   2. Peer mentors have an important role
8. Management Programs for Centrelink and NDIS assessment requirements need patients to have documentation that they are ‘fully stabilised’ and ‘fully managed’

To improve management and care planning, this site is working collaboratively to identify current Australian Fibromyalgia best practice services and programs.  If you can recommend programs or services please contact us.