Program Overview

Fibromyalgia is a common chronic pain disorder characterized by widespread pain, possibly related to central nervous system (CNS) pain sensitization and inadequate pain inhibition, and is associated with a constellation of symptoms including tenderness, stiffness, fatigue, sleep problems, cognitive impairment, and mood disturbances. According to American College of Rheumatology criteria, approximately 3% to 5% of the US population suffers from this condition. However, correct diagnosis of fibromyalgia is often obscured by the fact that symptoms associated with fibromyalgia overlap with other pain syndromes as well as some psychiatric disorders. Some of these conditions may share underlying mechanisms with fibromyalgia, and psychiatrists should take this into consideration when evaluating treatment options. While the exact pathophysiology of fibromyalgia remains elusive, findings from a controlled family study suggest that the etiology of fibromyalgia may include a genetic component. These genetic factors include polymorphisms in the serotonin- and dopamine-related genes along with a potential role for catechol-O-methyltransferase.

Treatment of fibromyalgia is complex and the evidence advocates a multifaceted approach. Nonpharmacologic treatments, such as cognitive-behavioral therapy and exercise, have been shown to help improve symptoms and restore function in individuals with fibromyalgia. The focus of nonpharmacologic treatment is based on identifying and eliminating maladaptive illness behaviors and increasing coping strategies of individuals with fibromyalgia. Pharmacologic treatments include antidepressant and anticonvulsant medications. Past studies have indicated that some antidepressants may have analgesic properties, and newer agents in the class show promise in the treatment of fibromyalgia.

This symposium will provide an overview of fibromyalgia and related conditions, the clinical and theoretical implications of genetic associations, and the various nonpharmacologic and pharmacologic treatment strategies.

Educational Objectives

After attending this symposium, participants should be better able to:

• Describe the epidemiology and shared underlying mechanisms of fibromyalgia and other central pain syndromes

• Review the theoretical and clinical implications of genetic factors in fibromyalgia

• Examine the role of CNS pain sensitization and inadequate pain inhibition in management strategies
  

• Evaluate nonpharmacologic and pharmacologic strategies in the treatment of fibromyalgia

Target Audience

This activity is intended for psychiatrists and other mental health care professionals attending the 2008 Annual Meeting of the American Psychiatric Association.

Accreditation Statement

This activity is no longer available for credit.

Credit Designation

This activity is no longer available for credit.

Faculty Disclosure

The American Psychiatric Association requires disclosure by faculty of CME activities of all financial interest(s) or other affiliation(s) with commercial organization(s) that may have a direct or in-direct interest in the subject matter of the scientific program. A “financial interest” may include, but is not limited to, being a shareholder in the organization; being on retainer with the organization; or having research or honoraria paid by the organization. An “affiliation” may include holding a position on an advisory committee or some other role or benefit to a supporting organization. The existence of such relationships does not necessarily constitute a conflict of interest, but the prospective audience must be informed of the faculty’s affiliation with every commercial entity by means of an acknowledgement in the printed materials. This policy is intended to openly identify any potential conflict(s) so that members of the audience in an educational activity are able to form their own judgments about the presentation.

Activity Chairperson

Lesley M. Arnold, MD
Associate Professor of Psychiatry
Director, Women’s Health Research Program
University of Cincinnati
Cincinnati, Ohio

Faculty

Daniel J. Clauw, MD
Professor of Medicine
Division of Rheumatology
Associate Dean for Clinical and Translational Research
Director, Chronic Pain and Fatigue Research Center
Michigan Institute for Clinical and Health Research
University of Michigan
Ann Arbor, Michigan

Dina Dadabhoy, MD
Rheumatologist
Northwest Rheumatology Specialists
Fox River Grove, Illinois

David A. Fishbain, MD, FAPA (dist.)
Professor of Psychiatry and Behavioral Sciences
Adjunct Professor of Neurological Surgery and Anesthesiology
Miller School of Medicine at the University of Miami
Miami, Florida

Don L. Goldenberg, MD
Professor of Medicine
Tufts University School of Medicine
Boston, Massachusetts
Chief of Rheumatology
Newton-Wellesley Hospital
Newton, Massachusetts