Introduction and Overview of FM

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EP: 1.Introduction and Overview of FM

EP: 2.Why FM is Often Misunderstood

EP: 3.The Pathophysiology of FM

EP: 4.Genetics and Other Risk Factors for FM

EP: 5.Characteristics of FM

EP: 6.Factors that Affect FM Symptoms

EP: 7.The Challenges of Diagnosing FM

EP: 8.Comorbidities and FM

EP: 9.Who is Diagnosing FM

EP: 10.Treatment Options and Supportive Therapies for FM

EP: 11.Treating Patients With FM

EP: 12.NSAID for Treatment of FM

EP: 13.Off Label Drugs and FM

EP: 14.Milnacipran as Treatment for FM

EP: 15.Duloxetine and Pregabalin as Treatment for FM

EP: 16.Long-Term Use of FM Treatments

EP: 17.Step Approach for FM Treatment

EP: 18.Combination Therapies and FM

EP: 19.Personalizing FM Treatment

EP: 20.Challenges and Unmet Needs in FM

EP: 21.Prospective Advancements and Final Thoughts on the Treatment of FM

Transcript

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Hello, and welcome to this peer exchange titled, understanding fibromyalgia; how experts are diagnosing and treating their patients. I am Dr Wendy Wright. I'm an adult and family nurse practitioner, and the owner of Wright & Associates Family Healthcare, a primary care clinic located in Amherst, New Hampshire. Joining me tonight are 3 of my physician colleagues. Would you just take a moment, gentlemen, to introduce yourself? Let's start with you, Dr Botsoglou.

Kostas Botsoglou, MD: Hi, I'm Dr Kostas Botsoglou, a rheumatologist and medical director at the Rheumatology Center of Western New York in Buffalo, New York.

Daniel Clauw, MD: Hi, Dan Clauw. I'm a rheumatologist in the Department of Anesthesiology, where I direct the Chronic Pain and Fatigue Research Center at the University of Michigan.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Thank you. And Dr Natelson.

Benjamin Natelson, MD: I'm a professor of neurology at the Mount Sinai School of Medicine and Director of the Pain and Fatigue Study Center there.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Thank you so much, gentlemen, for joining me tonight. I'm looking forward to having a great comprehensive discussion with you, where we're going to focus today on the diagnosis and treatment of fibromyalgia. We'll focus on the use of approved therapies and then hear the clinical perspectives from a multidisciplinary panel who frequently encounter patients with fibromyalgia. I want to welcome all of you who are watching today. Let's start in this first segment with a bit of a discussion on an overview of fibromyalgia. I'm just going to send these questions out there, and then I'd love it if we can all just dialogue and have some interactive conversation. And let's start out with what I think is one of the most important questions, and that is what is fibromyalgia?

Daniel Clauw, MD: Fibromyalgia is thought to be the poster child for a third mechanism of pain, where the pain is coming from the central nervous system rather than from the periphery or from the nerves. The term that's been used is nociplastic pain, which is sort of a mouthful. The old term for this was central sensitization where- and this is a synonymous term, but the international group of pain researchers voted a few years ago to formally acknowledge this third mechanism of pain where conditions like fibromyalgia, irritable bowel, headache, and many common pain conditions are really now thought to be driven by the same mechanism as we see front and center in fibromyalgia.

Kostas Botsoglou, MD: We know fibromyalgia is a complex and chronic condition, and it's characterized as Dr Clauw mentioned as musculoskeletal pain, fatigue, cognitive difficulties, as well as sleep disturbances. It can be challenging. As you know, we don't have any specific labs or imagings that can help us confirm its presence. But we rely on our clinical exam and also some questionnaires to help evaluate, diagnose this condition.

Benjamin Natelson, MD: And early on, it was thought to be a rheumatologic condition, but as Dr Clauw has mentioned, the more we've learned, the more we realize it's not inflammation in ligaments and joints, but it's really brain dysfunction in terms of pain control.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Now, I think of it very similarly to all of you. I think of it as a widespread pain condition for which we don't always know the cause or necessarily the triggers, but it's characterized by excessive fatigue and a heightened response to pain. And it's also characterized by sleep abnormalities in which those individuals often don't feel restored sleep or feel like they've been restored after they sleep.

Transcript edited for clarity.