A paradigm change to inform fibromyalgia research priorities by engaging patients and health care professionals.

Background: Research objectives should be focused toward advancing knowledge that has meaningful impact on health. However, research agendas are mostly driven by the health care community, with limited input from patients. Aims: In this study, prioirities of uncertainties for the management of fibromyalgia (FM) that could propel future research were identified by a defined process using the James Lind Alliance Priority Setting Partnership (JLA-PSP) methodology. Methods: As a first step, a survey was distributed across Canada that engaged patients, caregivers, and health care professionals to provide narrative input to eight open-ended questions regarding FM care. Responses were thematically condensed and synthesized into an initial list of 43 uncertainties used to guide a comprehensive literature search. Questions already effectively addressed in the literature were excluded, leaving 25 uncertainties that were ranked during a one-day consensus workshop. Results: Three broad themes emerged: the value of personalized targeted treatment and subgrouping of patients; the efficacy of various self-management strategies and educational initiatives; and identification of the ideal health care setting to provide FM care. Opioids and cannabinoids were the only specific pharmacologic interventions ranked as needing further research. Conclusions: The prioritized questions highlight the importance of recognizing the heterogeneity of FM symptoms, the need for a personalized treatment approach, and a better understanding of the value of self-management strategies. This is the first study that uses an established and transparent methodology to engage all FM stakeholders to help inform researchers and funding bodies of clinically relevant research priorities.

Contexte: Les objectifs en matière de recherche devraient se concentrer sur l'avancement des connaissances qui ont des effets significatifs sur la santé. Toutefois, les programmes de recherche sont surtout définis par le milieu des soins de santé, tandis que la contribution des patients demeure limitée.Objectifs: Dans cette étude, les incertitudes prioritaires pour la prise en charge de la fibromylagie, qui pourraient donner lieu à de futures études, ont été déterminées selon un processus fondé sur la méthodologie du Partenariat d'établissement des priorités de la James Lind Alliance.Méthodes: Comme première étape, une enquête a été distribuée partout au Canada auprès de patients, de prestataires de soins et de professionnels de la santé afin d'obtenir leurs réponses sous forme narrative à huit questions ouvertes concernant les soins relatifs à la fibromyalgie. Les réponses ont été regroupées par thèmes et résumées dans une liste initiale de 43 incertitudes qui a été utilisée pour orienter une recherche exhaustive de la littérature. Les questions déjà abordées de manière efficace dans la littérature ont été exclues, tandis que les 25 incertitudes restantes ont été classées dans le cadre d'un atelier de recherche de consensus d'une journée.Résultats: Trois grands thèmes se sont démarqués : l'utilité des traitements ciblés personnalisés et de la division des patients en sous-groupes; l'efficacité de diverses stratégies d'auto-prises en charge et initiatives éducatives; et la détermination du cadre de soins de santé idéal pour dispenser les soins relatifs à la fibromyalgie.Conclusions: Les questions priorisées soulignent l'importance de reconnaître l'hétérogénéité des symptômes de la fibromyalgie, la nécessité d'une approche de traitement personnalisé et une meilleure compréhension de l'utilité des stratégies d'auto-prise en charge. Il s'agit de la première étude à utiliser une méthodologie établie et transparente pour impliquer toutes les parties concernées par la fibromyalgie pour aider à faire connaître aux chercheurs et aux agences de financement les priorités pertinentes sur le plan clinique.

Fibromyalgia.

Fibromyalgia is a chronic pain condition present in 2-4% of the population. Fibromyalgia consists of widespread pain with similarities to neuropathic pain in clinical findings, pathophysiology, and neuropharmacology. Pain is the predominant symptom and allodynia and hyperalgesia are common signs. Extreme fatigue, impaired cognition and nonrestorative sleep difficulties coexist in addition to other somatic symptoms. Research including neuroimaging investigations shows abnormalities in neurotransmitters and an abnormal response to pain. Altered pain processing peripherally and centrally contribute to central sensitization and a dampened effect of the diffuse noxious inhibitory control (DNIC). Successful management incorporates education of the patient in self-management skills, cognitive behavioral therapy (CBT), exercise, and drug therapy. Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs) (duloxetine and milnacipran), α2-δ ligands (gabapentin and pregabalin) are effective in reducing pain by≥30%. Some success has been shown with dopamine agonists (pramipexole), tramadol, other opioids and cannabinoids (nabilone). Further evidence-based trials using complementary treatments are needed. Fibromyalgia is complex and requires a multidisciplinary approach to treatment. Patient self-management is key.

Fibromyalgia: presentation and management with a focus on pharmacological treatment.

Fibromyalgia is a condition with widespread muscle pain. Prevalence studies showed that 2% to 7% of the population have fibromyalgia, which affects approximately one million Canadians. Fibromyalgia is most common in women, but it also involves men and children. As with most chronic illnesses, the causes of fibromyalgia are unknown. However, recent research supports underlying abnormalities in the central nervous system, which supports fibromyalgia as a chronic disease state and valid clinical entity. Pain is the primary symptom, often accompanied by overwhelming fatigue, sleep dysfunction and cognitive impairment. In 1990, the American College of Rheumatology developed diagnostic criteria for the diagnosis of fibromyalgia. Lifestyle changes, including pacing of activities and aerobic exercise, are very important in managing fibromyalgia symptoms. Emotional and behavioural therapy can also be helpful. Controlled trials of antidepressants, gabapentinoids, tramadol, zopiclone and sodium oxybate have shown effectiveness in fibromyalgia patients. Pregabalin and duloxetine were recently approved in the United States. Effective management of fibromyalgia is complex and requires a multidisciplinary treatment approach. Response and tolerance of different therapeutic interventions vary from patient to patient. Recent advances in the pathophysiology of fibromyalgia offer hope for new and improved therapies in the management of this disabling condition.