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Prognosis

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Fibromyalgia

Abstract

Fibromyalgia (FMS) is a widespread chronic pain syndrome with elements of neurological dysfunction, musculoskeletal deconditioning, and psychiatric ailment. While not fatal, FMS causes significant interpersonal distress, pain that is often physically limiting, reduced overall functional and mental capacity, and a reduced quality of life, which serve as measureable outcomes when considering prognosis. FMS symptoms are historically refractory to numerous therapeutic interventions successful at treating other forms of chronic pain. Studies have shown the greatest duration and degree of therapeutic response in these patients to be associated with multimodal therapeutic approaches consisting of both pharmacologic and non-pharmacologic interventions. Prognosis is traditionally poor with more conventional mono-modal therapies; however, durable and meaningful responses have been demonstrated in patients using the appropriate combination of medical, physical, and cognitive-behavioral therapy. Currently, in the USA, Food and Drug Administration (FDA)-approved medications to treat FMS include duloxetine, milnacipran, and pregabalin. With both analgesic and antidepressant properties, these agents are effective both individually, and increasingly so when combined with physical therapies focused on the improvement and maintenance of mobility, and cognitive-behavioral therapies focused on improving mood, identifying life stressors, and developing adaptive coping mechanisms. Prognosis may correlate with disease severity, which can be classified based on a number of syndromic features present in patients with FMS. The historically poor prognosis for patients with FMS may reflect data from patients treated with conventional monotherapies. Review of recent literature to date at the time of this publication showed no formal data supporting an improved prognosis over the long term. However, an improved prognosis in patients with FMS is likely to follow a heightened awareness among patients and clinicians regarding the need for multimodal therapeutic interventions for this polygenic disorder.

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Authors and Affiliations

  1. Department of Anesthesiology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 604, Rochester, NY, 14608, USA

    Dr. Ryan D. McConn MD

  2. Department of Anesthesia and Critical Care, University of Chicago, 5841 S. Maryland Avenue, MC 4028, Chicago, IL, 60637, USA

    Assoc. Prof. Magdalena Anitescu MD, PhD

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  1. Dr. Ryan D. McConn MD
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Correspondence to Ryan D. McConn MD .

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  1. Voluntary Faculty, Department of Anesthesiology, Center for Pain Medicine, University of California San Diego,, Lexington, South Carolina, USA

    Erin Lawson, MD

  2. Professor of Clinical Anesthesiology,Chief, Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, La Jolla, California, USA

    Mark S. Wallace, MD

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McConn, R., Anitescu, M. (2015). Prognosis. In: Lawson, MD, E., Wallace, MD, M. (eds) Fibromyalgia. Springer, Cham. https://doi.org/10.1007/978-3-319-15820-4_4

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