2012 Canadian Fibromyalgia Guidelines

Source: Canadian Rheumatology Association

You can download the 2012 Canadian Fibromyalgia Guidelines from the Canadian Rheumatology Association’s website

Mary-Ann Fitzcharles1,2, Peter A. Ste-Marie2,3, Don L. Goldenberg4, John X. Pereira5, Susan Abbey6, Manon Choinière7, Gordon Ko8, Dwight Moulin9, Pantelis Panopalis1, Johanne Proulx10, Yoram Shir

1. Division of Rheumatology, McGill University, Montreal, Quebec, Canada
2. Alan Edwards Pain Management Unit, McGill University Health Center, Montreal, Quebec, Canada
3. Faculty of Law, Université de Montréal, Montreal, Quebec, Canada
4. Division of Rheumatology, Tufts University School of Medicine, Boston, Massachusetts, USA
5. Faculty of Medicine, University of Calgary, Alberta, Canada
6. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
7. Centre de la recherche du Centre hospitalier de l’Université de Montréal; Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
8. Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
9. Departments of Clinical Neurological Sciences and Oncology, University of Western Ontario, London, Ontario, Canada
10. Patient representative

Address corresponding author: Mary-Ann Fitzcharles, Montreal General Hospital, McGill University Health Centre, 1650 Cedar ave, Montreal, Quebec, H3G 1A4
Tel no: (514)-934-1934#44176
Fax no: (514)-934-8239
E-mail: mary-ann.fitzcharles@muhc.mcgill.ca

Canadian Fibromyalgia Guidelines Committee (CFGC)

Mary-Ann Fitzcharles (rheumatologist/pain physician)
Peter Ste-Marie (research assistant/coordinator)
Don Goldenberg (rheumatologist and external advisor)
John Pereira (family physician)
Susan Abbey (psychiatrist)
Manon Choinière (psychologist)
Gordon Ko (physiatrist)
Dwight Moulin (neurologist)
Pantelis Panopalis (rheumatologist/epidemiologist)
Johanne Proulx (patient representative)
Yoram Shir (pain physician)

This document and its recommendations have been endorsed by the Canadian Pain Society (CPS) and the Canadian Rheumatology Association (CRA).

Conflicts of interest

Mary-Ann Fitzcharles has received consulting fees, speaking fees and/or honoraria from Biovale, Janssen, Lilly, Pfizer, Purdue, and Valeant (less than $10,000).
Peter Ste-Marie is supported by a grant from the Louise and Alan Edwards Foundation.
Don Goldenberg has received consulting fees, speaking fees and/or honoraria from Forest, Lilly and Pfizer (less than 10 000$). He has also received grant support from Pfizer.
John Pereira has received independently-awarded research support from Pfizer Canada (greater than $10,000).
Susan Abbey has received consulting fees, speaking fees and/or honoraria from Lilly, Lundbeck and Pfizer (less than $10,000).
Manon Choinière has received unrestricted research support from Pfizer Canada and AstraZeneca. Consulting fees and honoraria were also given from Pfizer (less than $5,000).
Gordon Ko has received consulting fees, speaking fees and/or honoraria from Allergan, Mayer, Boehringer-Ingelheim, Genzyme, Janssen, Lilly, Merck, Pfizer, Purdue, Shire and Valeant.
Dwight Moulin has received consulting, speaking fees and/or honoraria from Janssen, Lilly, Paladin, Pfizer and Valeant. He has also received independentlyawarded research funding from Pfizer Canada (greater than 10 000$).
Pantelis Panopalis has received consulting fees and/or honoraria from Abbott, Bristol-Myers Squibb and Pfizer (less than $10,000).
Joanne Proulx has no conflicts of interest.
Yoram Shir has received consulting, speaking fees and/or honoraria from AstraZeneca, Janssen, Paladin, Pfizer and Purdue.
The needs assessment was funded by Valeant.

National Fibromyalgia Guideline Advisory Panel (NFGAP)

Dr. Pierre Arsenault, Dr. Arsenio Avila, Dr. André Bélanger, Judy Boyd, Dr. Monique Camerlain, Dr. Doreen Campbell, Dr. Ken Chisholm, Dr. Manon Côté, Betty Downey, Dr. Ruth Dubin, Dr. Alan Faiers, Dr. Lena Galimova, Dr. Bruce Garfield, Dr. Rodney Glynn-Morris, Dr. Allan Gordon, DC François Hains, Dr. Richard Henry, Dr. David Hunt, Suzie Joseph, Dr. Roman Jovey, Dr. Alan Kaplan, Dr. André Lalonde, Louise Lamb, Dr. Howard Margolese, Dr. May Ong, Dr. Saul Pilar, Anna Serapins, Dr. Ian Shiozaki, Dr. David Shulman, Dr. Pamela Squire, Dr. Allen Steverman, Dr. Ellen Thompson, Dr. Cory Toth, Dr. Jean-Luc Tremblay, Dr. Paula Williams

Disclaimer: This document, including all annexes and particularly the recommendation statements, was created to provide guidance for healthcare professionals. Therefore, the document has no legal value.

• ABSTRACT
• SECTION 1 : The diagnosis
• 1.1 How is fibromyalgia diagnosed?
• 1.1.1 The clinical presentation of fibromyalgia
• 1.1.2 The symptom complex in persons with fibromyalgia
• a) Pain
• b) Other associated symptoms present in FM
• b.I Fatigue
• b.II Nonrestorative sleep
• b.III Cognitive dysfunction
• b.IV Mood disorder
• b.V Pain-related somatic symptoms
• b.VI Non-pain related symptoms
• Recommendation:
• 1.2 What physical abnormalities may be present in fibromyalgia?
• 1.2.1 The tender point examination
• Recommendations:
• 1.3 What investigations should be done in a patient presenting with widespread pain?
• Recommendation:
• 1.4 How should the diagnosis of fibromyalgia be confirmed?
• Recommendation:
• 1.5 Is there a role for application of diagnostic criteria for an individual patient?
• Recommendation:
• 1.6 What conditions can present similarly to FM?
• Recommendation:
• 1.7 What is the recommended patient trajectory?
• Recommendations:
• 1.8 How can prejudice and scepticism regarding the validity of fibromyalgia be countered?
• Recommendation:
• 1.9 What causes fibromyalgia and how is this condition explained in physiological terms?
• Recommendations:
• SECTION 2 : Management
• 2.1 What are the treatment strategies for fibromyalgia?
• Recommendations:
• 2.2 Non-pharmacologic treatment
• 2.2.1 Self-management strategies
• Recommendations:
• 2.2.2 Multicomponent therapy
• Recommendation:
• 2.2.3 Psychological interventions
• Recommendations:
• 2.2.4 Exercise
• Recommendation:
• 2.2.5 Complementary and alternative medicines (CAMs)
• Recommendations:
• 2.3 Pharmacologic treatments
• Recommendations:
• 2.3.1 Analgesic treatments (Acetaminophen and Nonsteroidal antiinflammatory drugs [NSAIDs])
• Recommendations:
• 2.3.2 Opioid treatments
• Recommendations:
• 2.3.3 Cannabinoid treatments
• Recommendation:
• 2.3.4 Antidepressants with pain modulating effects
• Recommendations:
• 2.3.5 Anticonvulsants with pain modulating effects (α2- δligand drugs)
• Recommendation:
• 2.3.6 Other pharmacologic agents
• Recommendation:
• SECTION 3 : The outcome
• 3.1 How should patients with FM be followed?
• Recommendations:
• 3.2 What factors may help predict outcome in FM?
• Recommendations:
• 3.3 What measures of outcome may be used to follow patients with FM?
• 3.3.1 Examples of tools to assess function, global status and quality of life
• 3.3.2 Examples of tools to assess pain
• Recommendations:
• 3.4 What recommendations can be given regarding work?
• Recommendations:
• 3.5 How can healthcare costs be contained when treating patients with FM?
• Recommendation:
• Conclusion
• References