2=moderate,considerableproblems,oftenpresentand/oratamoderatelevel
3=severe:pervasive,continuous,life-disturbingproblems.
Andadding
ascorefortheextent(severity)ofsomaticsymptoms*where:
0=nosymptoms
1=fewsymptoms
2=amoderatenumberofsymptoms
3=agreatdealofsymptoms.
*Somaticsymptomsthatmightbeconsidered:musclepain,IBS,fatigue/tiredness,thinkingor
rememberingproblem,muscleweakness,headache,pain/crampsintheabdomen,numbness/tingling,
dizziness,insomnia,depression,constipation,painintheupperabdomen,nauseanervousness,chest
pain,blurredvision,fever,diarrhoea,drymouth,itching,wheezing,Raynaud’s,hives,welts,ringingin
ears,vomiting,heartburn,oralulcers,lossof/changeintaste,seizures,dryeyes,shortofbreath,lossof
appetite,rash,sunsensitivity,hearingdifficulties,easybruising,hairloss,frequenturination,painful
urination,bladderspasms.
NewcriteriasummarizedfromWolfeFetal.TheAmericanCollegeofRheumatologyPreliminary
DiagnosticCriteriaforFibromyalgiaandMeasurementofSymptomSeverity.ArthritisCare&Research
2010;62:600–10.
ManagementofCWPandfibromyalgia
Theultimategoalofpainrehabilitationistoimprovequalityoflifeandsenseof
well-being rather than focus on pain reduction. With improvement in factors
such as sleep or anxiety and improvements in physical activity and general
participation,distraction frompain isimprovedandtheoverall senseof threat
reduced.Thiswillinturnreducethevolumeofpainsignal.
1
Managementissue1:explanationandreassurance
It is of paramount importance to consider carefully the way in which an
explanationisgivenastothenatureofthecondition.Thismaytakesometime
and may be best approached in the context of a multidisciplinary team
(psychologists,physiotherapists,OTs,doctors).
• It is important to assess the effect of symptoms on the patient’s life, and
developagoodrapportsopsychosocialissuescanbediscussed.
• Theemphasisintheexplanationshouldbereassurancethatthereisnoserious
underlyinginflammatoryorsystemiccondition,thatnothinghasbeenmissed,
andthereisnodamagetothejointsandmuscles.Thisfearblocksengagement
withexplanationsandunderminesrehabilitationstrategies.
• Effectiveexplanationusesappropriatelanguageandstoriestohelpthepatient
understand:
• moreaboutthecomplexityofpainprocessingandwhyitgoeswrong.