Exercise and antidepressants improve fibromyalgia

Journal of Family Practice, April, 2004 by Anna Quisel, James Gill, Dene Walters

(56.) Burckhardt C, Clark S, Bennett R. The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991; 18:728-733.

The toll of fibromyalgia

In community-based studies, 2% of Adults (16) and 1.2% to 6.2% of school-age children screened positive for fibromyalgia. (17-19) Females are at higher risk than males, and risk increases with age, peaking between 55 and 79 years.

Morbidity associated with fibromyalgia is considerable. (16,20,21) In one report, persons with fibromyalgia scored lower on a well being scale than persons with rheumatoid arthritis or advanced cancer. (22)

Persons with fibromyalgia use an average of 2.7 drugs at any one time for related symptoms, and they make an average of 10 outpatient visits per year and are hospitalized once every 3 years. (23)

Fibromyalgia has been associated with Osteoporosis. (24) Compared with other rheumatic diseases, fibromyalgia results in a high rate of surgery, including hysterectomies, appendectomies, back and neck surgery, and carpal tunnel surgery. (23,25) Among adults who seek medical attention, fewer than 30% have been reported to recover from fibromyalgia within 10 years of onset. (26-29)

However, symptoms tend to remain stable (27) or lessen over time, (28,30-32) with no increase in 10-year mortality. (33) Children appear much more likely to recover from fibromyalgia, with complete resolution in more than 50% by 2 to 3 years in several studies. (13,18,34,35)

Cormorbid conditions

Compared with other rheumatologic conditions, persons with fibromyalgia more often suffer from comorbid conditions, (23) including chronic fatigue syndrome, migraine headaches, irritable bowel syndrome, irritable bladder symptoms, temporomandibular joint syndrome, myofascial pain syndrome, restless legs syndrome, and affective disorders. (23,36,37)

Assessing treatment efficacy: Outcome tools online

The Fibromyalgia Impact Questionnaire: myalgia.com/Paintools/fibromyalgia_impact_questionnair1.htm

Visual analogue pain scale: www.outcomesassessment.org/QVAS Form.pdf

Arthritis Self-Efficacy Questionnaire: patienteducation.stanford.edu/research/searthritis.pdf

DRUG BRAND NAMES

Amitripyline * Elavil

Citalopram * Celexa

Clomipramine * Anafranil

Cyclobenzaprine * Flexeril

Dothiepin * Prothiaden

Fluoxetine * Prozac

Maprotiline * Ludoimil

Corresponding author: Anna Quisel, MD, c/o Cheryl Mongillo, Department of Family and Community Medicine, Christiana Care Health Systems, 1401 Foulk Road, Wilmington, DE 19803. E-mail: bretandanna@comcast.net.