Over the past 5 years rheumatologists have reported a significant increase in the number of patients referred to them. This is probably due to increased awareness of fibromyalgia by physicians in the primary care setting, not a recent increase in the incidence of fibromyalgia.
In speaking to patients & physicians many categorize the condition according to the following rating: mild, moderate, or severe.
- Mild fibromyalgia is characterized by mild muscle pain—that is, a pain level of 1, 2, or 3 on a 10-point scale. It is little or no hindrance in everyday functioning. Treatment is often by a primary care practitioner (PCP), who may prescribe a tricyclic antidepressant (Elavil, Sinequan, etc.). Symptoms respond to education, instruction in sleep hygiene, self-directed exercise, and over-the-counter medications.
- Moderate fibromyalgia is characterized by moderate muscle pain—that is, a pain level of 4, 5, or 6 out of 10. It somewhat hinders everyday functioning. Some PCPs with pain management experience can manage moderate fibromyalgia, whereas others refer patients to physical medicine and rehabilitation (PM&R) specialists, also known as physiatrists. Patients with moderate fibromyalgia usually need supervised exercise, usually with a physical therapist. They often need a combination of medicines, including anti-inflammatories, muscle relaxants, anticonvulsants, and selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). Patients with moderately severe fibromyalgia often need prescription analgesics.
- Severe fibromyalgia is characterized by severe muscle pain—that is, a pain level of 7, 8, 9, or 10 out of 10. It greatly hinders everyday functioning. Patients are either unable to work or must frequently call in sick. Some have access to an in-patient multidisciplinary program, but usually a physiatrist or other pain management specialist puts together an individualized program that involves several health care providers specializing in the treatment of severe fibromyalgia. They titrate their treatments to maximize pain relief and functioning while minimizing pain flares.
I would classify my fibromyalgia as moderate. How about you- how would you rate your condition & has your physician ever mentioned a rating scale?
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