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Management of fibromyalgia syndrome: prevalence, experience and potential use

Fibromyalgia syndrome (FMS) is the second most common rheumatologic disease. It is a female predominant syndrome with unknown aetiology, characterized by chronic widespread pain, multiple tender points and additional symptoms such as psychological distress, fatigue, no restorative sleep, morning stiffness, headache, paresthesias, irritable bowel and bladder syndrome.
The prevalence of fibromyalgia is 1-3% varying from country to country. Study in Norway (Nord-Trondelag) found the prevalence of fibromyalgia to be 3.2%, by gender 5.2% for women and 0.9% for men, respectively (1). A population study in USA of Wolfe in 1995 has shown a prevalence to be 2%, relatively 3.5% for women and 0.5% for men (2).
The work capacity of people with FMS is poor (3). In Norway the percentage of patients who are out of work is relatively large, and FMS represents the largest group of women who recently got disability pension, furthermore the group is on the top of those who got negative answer to their disability pension application (4).
Currently, there is no effective cure for FMS. A recent clinical review by Dr. Don LG. and Co. (5) concluded that there is strong evidence that the following managements are effective for symptom improvement: including medications such as amitriptyline and cyclebenzaprine; and non-pharmaceutical interventions such as cardiovascular exercise and patient education. The review also shows that there is modest evidence that following treatments are effective: including medications such as tramdol, SDSRIs, SNRIs and Pregabalin; and non-pharmaceutical alternative interventions such as strength training, acupuncture, hypnotherapy, biofeedback and balneotherapy. One of the reasons that people with FMS are more likely to use alternative therapies is because of adverse effects of the pharmaceuticals, especially for long-term use.
It is necessary to establish multi-modality management to relieve symptoms and improve health-related quality of life in people with FMS; and to explore individual patient characteristics who would respond differently to the therapies.
Earlier studies found that as many as 66% to 90% of patients with FMS used complementary and alternative medicine (CAM) therapy. A recent survey showed that 91% of those with FMS in America used at least one form of CAM therapies (6). Until now, there is no published study about use of CAM therapies among people with FMS in Norway.

Prosjektleder: Chun-Lan Zhang


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