You need to enable JavaScript to run this app.
☰
×
About
Methodology
The Team
News
Conference
Contact Us
About
Methodology
The Team
News
Conference
Contact Us
Adult Fibromyalgia
Adult Fibromyalgia
Diagnosis
Medication
Recommendation
Does patient have comorbid psychiatric disorder(s)?
Yes
No
X
Yes
Adequate
response
Adequate
response
Partial
response
Inadequate or partial
response
Yes
No
Inadequate response
Fibromyalgia
Patient Education
Nature of Disease
Sleep Hygeine
Treatment approaches / expectations
Comorbid psychiatric
disorder present?
See corresponding
decision support and treat
concurrently
Assess
response
Maintenance
Therapy
Pharmacotherapy
SOR A
Exercise Program
SOR A
Aerobic
Resistance Training
Aquatherapy
Psychologic
Interventions
Recommend
(SOR A)
:
CBT
CBT-I
Consider:
ACT
Assess for predominant symptoms
for monotherapy (or augmentation)
None
Depression
Duloxetine
Fatigue
First: Duloxetine
Second: Milnacipran
Sleep disturbance
Pregabalin
Gabapentin
TCA
3 month trial after
slow titration to recommended dose
Maintenance
Therapy
Augment with agent from different class based
on predominant symptoms
Amitriptyline
Desipramine
Activating
Nortriptyline
Imipramine
Consider specialty referral and psychologic interventions
Specialty
referrals
Consider:
Physical Therapy
Rheumatology
Pain Management
PM&R
Sleep Medicine
Psychiatry
Psychologic Interventions
(if not done previously)
CBT
CBT-I
ACT
Have at least 3 trials of different
medication classes been prescribed?