Arnold Lesley M, Clauw Daniel J
a Department of Psychiatry and Behavioral Neuroscience, Women's Health Research Program , University of Cincinnati College of Medicine , Cincinnati , OH , USA.
b Departments of Anesthesiology, Medicine (Rheumatology), and Psychiatry, and the Chronic Pain and Fatigue Research Center , The University of Michigan , Ann Arbor , MI , USA.
Postgrad Med. 2017 Sep;129(7):709-714. doi: 10.1080/00325481.2017.1336417. Epub 2017 Jun 19.
The current diagnostic and treatment pathway for patients with fibromyalgia (FM) is lengthy, complex, and characterized by multiple physician visits with an average 2-year wait until diagnosis. It is clear that effective identification and appropriate treatment of FM remain a challenge in current clinical practice. Ideally, FM management involves a multidisciplinary approach with the preferable patient pathway originating in primary care but supported by a range of health care providers, including referral to specialist care when necessary. After the publication of individual clinical studies, high-quality reviews, and meta-analyses, recently published FM treatment guidelines have transitioned from an expert consensus to an evidence-based approach. Evidence-based guidelines provide a framework for ensuring early diagnosis and timely adoption of appropriate treatment. However, for successful outcomes, FM treatments must adopt a more holistic approach, which addresses more than just pain. Impact on the associated symptoms of fatigue and cognitive problems, sleep and mood disturbances, and lowered functional status are also important in judging the success of FM therapy. Recently published guidelines recommend the adoption of a symptom-based approach to guide pharmacologic treatment. Emerging treatment options for FM may be best differentiated on the basis of their effect on comorbid symptoms that are often associated with pain (e.g. sleep disturbance, mood, fatigue). The current review discusses the most recently published Canadian guidelines and the implications of the recent European League Against Rheumatism (EULAR) recommendations, with a focus on the challenges of implementing these guidelines in current clinical practice.
纤维肌痛（FM）患者目前的诊断和治疗途径漫长、复杂，其特点是需要多次就诊，平均等待两年才能确诊。显然，在当前临床实践中，有效识别和适当治疗FM仍然是一项挑战。理想情况下，FM管理采用多学科方法，最佳的患者治疗途径始于初级保健，但得到一系列医疗保健提供者的支持，必要时包括转诊至专科护理。在发表了个体临床研究、高质量综述和荟萃分析之后，最近发布的FM治疗指南已从专家共识转向基于证据的方法。基于证据的指南为确保早期诊断和及时采用适当治疗提供了框架。然而，为了取得成功的治疗效果，FM治疗必须采用更全面的方法，这种方法不仅要解决疼痛问题。对疲劳、认知问题、睡眠和情绪障碍以及功能状态降低等相关症状的影响，在判断FM治疗的成功与否时也很重要。最近发布的指南建议采用基于症状的方法来指导药物治疗。FM的新兴治疗选择可能最好根据它们对通常与疼痛相关的共病症状（如睡眠障碍、情绪、疲劳）的影响来区分。本综述讨论了最近发布的加拿大指南以及欧洲抗风湿病联盟（EULAR）近期建议的影响，重点关注在当前临床实践中实施这些指南所面临的挑战。
