Susan Chrostowski, DNP, MS, APRN: Demystifying Fibromyalgia

Rheumatology Network sat down with Susan Chrostowski, DNP, MS, APRN to discuss her 14th Annual Rheumatology Nurses Society Conference presentation, entitled “Demystifying Fibromyalgia for the Nurse and Advanced Practice Provider.” Chrostowski is an Assistant Clinical Professor at Texas Woman’s University. We discuss the factors that affect quality of life in patients with fibromyalgia, the current diagnostic criteria and assessment tools for this patient population, and management considerations for the rheumatology nurse.

Rheumatology Network: Can you tell me a little bit about the definition and pathophysiology of fibromyalgia?

Susan Chrostowski, DNP, MS, APRN: Absolutely. Fibromyalgia is kind of a complicated condition. When it was first identified, years and years ago, they thought it was a muscle problem. And that's kind of the basis of where the name came from. “Myo” means muscle. And then as time went on, they figured out that it's a nerve processing problem. It’s a widespread pain condition and it's very challenging for those of us that work in rheumatology because it doesn't seem like there’s anything that we do can help it. And we've always kind of considered pain as coming from 2 different camps. So, you had one side that, you know, there was an injury and your peripheral nerves were telling you something was wrong. And that was one pain pathway. The other is nerve-related pain; maybe there's been damage or trauma to nerve, and you have nociceptive pain and nerve-related pain. But now they're really thinking that this is a totally different mechanism. There's a theory out there that it has to do with the pain processing. So, the person's brain is telling them there's pain when we really can't see any reason for there to be. So, it has to do with the neurotransmitters. They call it a central brain processing problem.

RN: What are some of the factors that affect quality of life for this patient population?

SC: It can be really devastating on their quality of life because when you have widespread chronic pain, that kind of consumes It's always there, it's always on your mind, it inhibits you from being able to do all the activities that you want to do. And other people don't understand that it's not like that you have a broken leg and everybody can see the cast on your leg and know that you have pain from that. These are symptoms that other people can't see, and other people don't understand. You look healthy. And so, it can also be very isolating for them as far as their quality of life, because they're not understood oftentimes by their own family members. And there are still a lot of old school thought in the medical community that it's just a psychological problem, or it's not real and they don't feel validated. And so, it can be very challenging for these patients.

RN: Why is Fibromyalgia more prevalent in women?

SC: That's an interesting question. We really don't know the answer. We think that maybe there's a underlying hormonal predisposition for women, that there’s something about the hormone interactions that cause it in women. It is more prevalent in women, the majority of patients are women, but it does occur in men. So, we have a lot of conditions across all medical specialties that some are more prevalent in men and some are more prevalent in women and we don't know why.

RN: What are the current diagnostic criteria and assessment tools for patients with fibromyalgia?

SC: The newest published tools out of the American College of Rheumatology involve 2 assessment instruments: the widespread pain index and the symptom severity scale. So, if someone comes in with this complaint of widespread pain and you suspect fibromyalgia, then these are tools that can be used to evaluate whether that's actually what's going on, but also it can be given ongoing to assess disease activity and response to treatment. So, the widespread pain index symptom severity tool, those are the current instruments recommended for this.

RN: Can you tell us a little bit about both pharmacological and non-pharmacological treatment strategies for patients with fibromyalgia?

SC: Absolutely. What we know is that there's only 3 medications that have been approved by the FDA to be used for treatment of this. And those were approved years ago, like 2007. We have not had any new treatments in several years and we haven't made a lot of progress. Even with those drugs that were approved, it's only going to be about maybe a 40% improvement in their symptoms. So basically, what we know is that while there are several medications that might help lessen the symptoms a little bit, there's nothing that's going to cure it or take it all away. There are also other medications like antidepressants and muscle relaxants that some people can find beneficial, especially when taking it bedtime. And sometimes if we can improve the sleep quality, it helps improve the overall symptoms. So one of the non-pharmacological things we kind of look at is sleep and sleep hygiene. Try to coach them in avoiding caffeine at bedtime and having a cool, comfortable sleep environment, things like that. Other things include low impact exercise and exercises we've found that are probably helpful. Some of the studies show aquatic swimming and things like Tai Chi and yoga can be very beneficial. And we think that it's the stimulation of endorphins that helps lessen the pain from the condition.

RN: What are some management considerations for the rheumatology nurse?

SC: Basically, it's important for the rheumatology nurse to display understanding and validation for the patient. This is a real condition; we know that this is very difficult for you. I want to help you to manage your condition. So, you empower the patient to have control over helping to manage their condition. And you validate that, yes, this is real. I know it's difficult. Let's see what we can do that can help you improve your symptoms, and then go through options. You know, try some medicines, if they need to improve their sleep, try strategies to reduce their stress. Another strategy is cognitive behavioral therapy. If we can refer them to someone that can do some behavioral therapy or mindfulness is also helpful. There are apps on the phone so they can practice the mindfulness. Reducing stress levels, improving sleep, maybe finding medicines that might help them some, that's where the nurse comes in to really help educate the patient on their condition and empower them to help self-manage their care.

RN: Is there anything else you would like our audience to know before we wrap up?

SC: And I just appreciate the opportunity to be able to address this condition because it's one of the most prevalent conditions we see in rheumatology, secondary to osteoarthritis. So, it's just a large number of patients. And I think it's valuable for rheumatology nurses to be able to address this and use the tools that we do have available. And so, I appreciate the opportunity.