The High Authority for Health (HAS) has just published new recommendations on the diagnosis and management of adult fibromyalgia.
Why these new recommendations?
Fibromyalgia is mainly reflected in chronic pain, sometimes associated with other symptoms, such as intense fatigue, sleep disorders, anxious, depressive or cognitive disorders, impacting quality of life. This chronic disease would affect 1.5 to 2 % of the population in France and 3 times more women than men.
The objective of these new recommendations is to help patients to live better with pain, in particular by improving their understanding of symptoms and their involvement in their treatment, essentially non -drug. It is also a question of preventing the risks linked to ineffective, even dangerous practices.
A difficult diagnostic
The diagnosis of fibromyalgia is difficult to establish: no biological or radiological examination makes it possible to assert it. It is based on a clinical examination, the presence of pain for more than 3 months, active listening to the patient and the use of evaluation tools (self-questionnaire, algorithms, etc.).
Recognize suffering
Once the diagnosis is made and the impact on the quality of life evaluated, it is essential to recognize the suffering of the patient. After a listening phase, an explanation phase of the disease and its management is necessary to mobilize the patient in his care. For this, the HAS will publish an information document at the end of September. Patient associations are also available to ensure another form of listening and support.
HAS already provides professionals in tools To help diagnosis and care: self-questionnaires (FIRST : Fibromyalgia Rapid Screening Tool ; QIF : self-administrative questionnaire of fibromyalgia impact), diagnostic criteriaalgorithms (diagnostic approach, therapeutic strategy), Information to exchange with the patientglobal printing scale for clinical change (PGI-C)… And « Rendezvous of good practices “Will be organized on September 30 online and will be an opportunity for experts from the working group to present the recommendations and answer questions live (registrations already open).
Put the patient back in motion
The therapeutic strategy is based on non -drug treatments with physical activity on the front line. For this, the HAS offers a Typology of physical exercises Taking into account the specificities linked to fibromyalgia. It is essential to help the patient better manage the symptoms on a daily basis to be able to continue their personal and professional activities.
Failing to be able to offer curative treatment, the objective of management is to set up adaptation and self -management strategies disease (alternating periods of activity and rest, participation in sessions oftherapeutic educationdevelopment of the workstation, etc.) and reassess them regularly, because the therapeutic strategy must be evolving to adapt to the fluctuation of symptoms. An in -depth evaluation on the psychological, social or professional level is also important to set up suitable support if necessary.
Avoid drug misuse
No drug has a marketing authorization in the indication of fibromyalgia. Some antidepressants and antiepileptics may be prescribed in low doses, in 2e intention, to relieve pain, but their benefit expected in fundamental treatment remains modest. The use of opioids must remain exceptional in the long run and their prescription made after a specialized opinion. Particular attention should be paid in case of misuse.
In 3e Line, neurostimulation techniques can be offered after advice.
Food diets offering specific restrictions (eg gluten -free, lactose -free, etc.) and taking food supplements outside of proven deficiencies have no demonstrated interest in fibromyalgia.
