2012 Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome

Mary-Ann Fitzcharles1,2, Peter A. Ste-Marie2,3, Don L. Goldenberg4, John X. Pereira5, Susan Abbey6, Manon Choinière7, Gordon Ko8, Dwight Moulin9, Pantelis Panopalis1, Johanne Proulx10, Yoram Shir2

FM is a valid syndrome affecting approximately one million Canadians. In the absence of any confirmatory test, the diagnosis is based clinically on the chief complaint of pain and associated symptoms of fatigue, sleep disturbance, cognitive changes, mood disorder and other somatic symptoms. A physical examination is within normal limits apart from tenderness of soft tissues, but without the requirement of examination of tender points to confirm a diagnosis. Investigations should be limited to simple laboratory testing, unless the clinical picture suggests some other diagnosis.

Primary care physicians are encouraged to establish a diagnosis of FM as early as possible without need for specialist confirmation. Symptoms of FM persist over time without any current treatment option offering a cure and with ideal care centered in primary care, incorporating a multimodal approach. Treatment plans should incorporate self-management techniques, goal setting and healthy lifestyles, with acknowledgement of psychological distress when present. Pharmacologic treatments should be initiated in low doses with gradual and cautious upward titration to minimize side effects. Continued medication use requires diligent evaluation with attention to need for continued use and emergence of adverse effects. Clinical outcome can be measured by a simple narrative report of symptom status without need for use of specific questionnaires. Any new symptom requires appropriate clinical evaluation and should not immediately be attributed to FM. Although there is currently no cure for FM, many patients achieve moderate symptom control and are able to lead active and fulfilling lives.

1 Division of Rheumatology, McGill University, Montreal, Quebec, Canada
2Alan Edwards Pain Management Unit, McGill University Health Center, Montreal, Quebec, Canada
3Faculty of Law, Université de Montréal, Montreal, Quebec, Canada
4Division of Rheumatology, Tufts University School of Medicine, Boston, Massachusetts, USA
5Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
6Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
7Centre de la recherche du Centre hospitalier de l’Université de Montréal; Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
8Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
9Departments of Clinical Neurological Sciences and Oncology, University of Western Ontario, London, Ontario, Canada
10Patient representative