248 Approach To Fibromyalgia In Primary Care

Faria R, Ribeiro A
Introduction and aim: Fibromyalgia (FM) has a prevalence of 2%. Consensus indicates that majority of FM patients should be diagnosed, treated and followed by Primary Health Care (PHC). Since in most cases FM is "forever", prevention is desirable, especially by Family Medicine Physicians (FMP) who are those that establish the first contact with patient and are in a privileged position to know the factors that preceded and/or accompany FM. The aim is to present an algorithm to approach FM in the context of PHC.
Method: Research in Pubmed and Evidence Based Medicine sites, of articles published between 2000 and 2010, written in Portuguese and English.
Results: The FM is a rheumatic disease of unknown cause and functional nature, which causes widespread pain in soft tissues and is accompanied by other variable quantitative/qualitative symptoms, such as sleep disturbances, fatigue and morning stiffness. A key feature of FM is the dissociation between the subjective elements prominent, often referred as severe and disabling, and the objective findings, virtually non-existent, apart from hypersensitivity pain that patients have when pressured by the doctor. The diagnosis is essentially clinical. There is no diagnostic testing and all results are normal. If any changes occur, it is due to other associated pathology. The patient and relatives education is an important therapeutic element. This shall transmit that there are 3 vicious cycles, started in pain, which must be broken for the better relief. The chronic pain state (CPS) results from: physical deconditioning, depression and sleep disturbance. Drug therapy is vast and it is all within reach of FMP. Other forms of treatment such as thermal therapy are moderately effective.
Conclusions: Knowledge of risk factors associated with CPS, characteristics of pro-pain personality, warning signs for development of FM and main criteria for referral are essential for a correct and timely approach of FM by PHC.
Approach to Fibromyalgia in Primary Care