Overview:
Fibromyalgia (FM) is a chronic widespread pain syndrome often associated with fatigue, sleep disturbance, functional impairment, and psychiatric co-morbidity. An estimated 6 million people in the United States and 2% of the worldwide population are affected by FM. Chronic widespread pain is the defining feature of FM. Patients have an increased sensitivity to pressure pain throughout the body. Emerging evidence suggests that an increased response to painful stimuli and enhanced pain experience from normally non-noxious stimuli reflect enhanced CNS processing of painful stimuli, characteristic of central sensitization. Pain derives partly from a generalized decrease in the pain perception threshold, reflecting discrimination of a nociceptive quality from a non-nociceptive quality. Since FM is primarily a CNS disorder, psychiatrists play an important role in detection and management. It has been well-documented that negative emotions such as depression and anxiety, and other negative psychological factors (e.g., loss of control, unpredictability in one's environment), and certain cognitive aspects (e.g., negative beliefs and attributions, catastrophizing) are associated with the onset and persistence of FM symptoms. Furthermore, exposure to physical, emotional, or environmental stressors may trigger the initiation of symptoms. The primary objective of this activity is to provide psychiatrists and other clinicians with the most up-to-date information regarding major components of fibromyalgia syndrome.
This is a 3-Part Series:
Click here for Part 1.
Click here for Part 2.
Target Audience:
Psychiatrists and psychiatric specialists who treat and manage patients with fibromyalgia syndrome and comorbid psychiatric illnesses
Learning Objectives:
1. Review the classification criteria recommended by ACR to confirm a diagnosis of FM
2. Describe the relationship between neurobiological factors and psychological, cognitive and behavioral factors in the onset of FM and the manifestation of patient symptoms
3. List the primary outcomes used to assess therapeutic efficacy (VAS-pain scores, pain threshold), psychological function (depression, anxiety), quality of life, fatigue, and sleep
4. Identify the classes of medications used to treat FM symptoms, including their associated benefits and risks
5. Explain the importance of a multidisciplinary approach to patient treatment and disease management
Faculty:
Lesley M. Arnold, MD (Chair)
Professor of Psychiatry
Director, Women's Health Research Program
University of Cincinnati College of Medicine
Cincinnati, OH
Daniel J. Clauw, MD
Professor of Anesthesiology and Medicine (Rheumatology)
Associate Dean for Clinical and Translational Research
Director, Chronic Pain and Fatigue Research Center
Director, Michigan Institute for Clinical and Health Research
The University of Michigan
Ann Arbor, MI
Release date: February 2009
Expiration date: February 2010
Estimated time to complete activity: 45 minutes
This activity is supported by an educational grant from Pfizer.
Accreditation Statement:
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and Independent Medical Education, LLC. PIM is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation:
Postgraduate Institute for Medicine designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Disclosure Statement:
The Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Lesley M. Arnold, MD (Chair)
Director, Women's Health Research Program
University of Cincinnati College of Medicine
Cincinnati, Ohio
Grants/Research Support: Eli Lilly and Company, Pfizer, Inc., Cypress Bioscience Inc., Wyeth Pharmaceuticals, Sanofi-Aventis, Boehringer Ingelheim, Allergan, Forest
Consultant: Eli Lilly and Company, Pfizer, Inc., Cypress Bioscience Inc., Wyeth Pharmaceuticals, Sanofi-Aventis, Boehringer Ingelheim, Sepracor, Forest Laboratories Inc., Allergan, Vivus, Inc., Organon, Takeda
Speakers Bureau: Eli Lilly and Company, Pfizer, Inc.
Daniel J. Clauw, MD
Professor of Anesthesiology and Medicine (Rheumatology)
Associate Dean for Clinical and Translational Research
Director, Chronic Pain and Fatigue Research Center
Director, Michigan Institute for Clinical and Health Research
The University of Michigan
Ann Arbor, MI
Consultant: Pfizer, Inc., Wyeth Pharmaceuticals, Cypress Bioscience Inc., Forest, Eli Lilly and Company
Contracted Research: Cypress Bioscience Inc.
The following planners and managers for this activity: Nimish Mehta, PhD (IME), Reha Kamdar, BSPharm (IME), William C. Lloyd, MD (TDC), Linda Graham, RN, BSN, BA (PIM), Jan Hixon, RN, BSN, MA (PIM), Trace Hutchison, PharmD (PIM), Julia Kirkwood, RN, BSN (PIM) and Jan Schultz, RN, MSN, CCMEP (PIM) hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
METHOD OF PARTICIPATION:
There are no fees for participating and receiving CME credit for this activity. During the period February 2009 through February 28, 2010; participants must:
1. Read the learning objectives and faculty disclosures
2. View each educational activity
3. Complete the posttest by recording the best answer to each question in the answer key on the online evaluation form
4. Complete the evaluation form online
An online statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.
MEDIA:
Internet
DISCLOSURE OF UNLABELED USE:
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), IME, LLC and Pfizer, Inc. do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, IME, LLC, and Pfizer, Inc. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
For questions about the accreditation of this activity, please contact PIM at information@pimed.com or 303-799-1930.
Bibliography:
1. Arnold LM, Hudson JI, Keck PE, Jr, Auchenbach MB, Hess EV. Comorbidity of fibromyalgia and psychiatric disorders. J Clin Psychiatry. 2006;67:1219-1225.
2. Arnold LM. Biology and therapy of fibromyalgia. New therapies in fibromyalgia. Arthritis Res Ther. 2006;8:212-231.
3. Beck A, Breth G, Hays R, Miller C. Psychiatric Disorders and Functional Disability in Patients with Fibromyalgia. The Permanente Journal. 2000;4:21-28.
4. Gendreau RM, Thorn MD, Gendreau JF, et al. Efficacy of milnacipran in patients with fibromyalgia. J Rheumatol. 2005;32:1975-1985.
5. McBeth J, Silman AJ. The role of psychiatric disorders in fibromyalgia. Curr Rheumatol Rep. 2001;3:157-164.
6. Mease PJ, Clauw DJ, Arnold LM, et al. Fibromyalgia syndrome. J Rheumatol. 2005;32:2270-2277.
7. Mease PJ, Russell IJ, Arnold LM, et al. A randomized, double-blind, placebo-controlled, phase III trial of pregabalin in the treatment of patients with fibromyaglai. J Rheumatol. 2008;35:502-514.
8. Mease PJ, Seymour K. Fibromyalgia: should the treatment paradigm be monotherapy or combination pharmacotherapy? Curr Pain Headache Rep. 2008;12:399-405.
9. Russell IJ, Mease PJ, Smith TR, et al. Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain 2008;136:432-444.
10. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160-72.
Technical Requirements:
A broadband internet connection
Operating system: Microsoft Windows 98 or later; Mac OS X
Web browser: Microsoft Internet Explorer 6.0 or later; Mozilla Firefox 1.5 or later; Apple Safari
Adobe Flash Player 9.0 or later
(Available at: Get.adobe.com/flashplayer/)
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