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Old 04-25-2014
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Default Treatment of Fibromyalgia .

Whats the best INITIAL therapy for FBM patients?

IIRC, Uworld recommends low intensity aerobic exercise BEFORE pharmacological therapy.

Well, im checking Kaplan Qbank now and they advocate the use of TCAs such as Amytriptiline BEFORE aerobic exercise.

Researching online shows that both methods are employed simultaneously, but that isnt enough for the NBME **** is it?

Patient information is another part of the treatment.

So what would you say if you were asked about the INITIAL tx for FBM?
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Old 04-25-2014
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I'll always try exercise first.. see if it works. if not then try TCA.
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Old 04-26-2014
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This is what kaplan qbank said in the explanation of one of the questions on fibromyalgia.

Step-wise Fibromyalgia Management:

1) Confirm the diagnosis and offer an explanation to the patient.

2) Start a low dose of a tricyclic medication (amitriptyline).

3) Nonsteroidal anti-inflammatory drugs, including ibuprofen are not
recommended as first-line therapy, but they may be useful in combination therapy.

4) Start low-impact aerobic exercise.

5) Referral for cognitive behavioral therapy.

6) Addition of an SSRI such as fluoxetine to a tricyclic, or use of a dual norepineohrine and SSRI (duloxetine) may be considered. Alternatives include gabapentin or pregabalin.

7) Tramadol may be added to assist in pain management if necessary.
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Old 04-26-2014
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Quote:
Originally Posted by mdsoon View Post
I'll always try exercise first.. see if it works. if not then try TCA.

i would go with uworld as well
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Old 04-27-2014
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Quote:
Originally Posted by hydrocephalus View Post
i would go with uworld as well
yeh, i searched through my uworld notes and i would stick with uworld as well... here is what it said.

"Initial FM treatment involves a multidisciplinary approach including patient education, regular aerobic exercise, and good sleep hygiene. Patients who do not respond to conservative measures may require medications. Tricyclic antidepressants (eg, amitriptyline) are preferred first-line drugs. Pregabalin, duloxetine, and milnacipran are alternate therapies approved for patients not responding to tricyclic antidepressants. Selection of the therapeutic agent should be tailored to patients based on their symptoms and the drug's side effect profile. Patients with persistent symptoms may require combination drug therapy, referral for supervised rehabilitation, pain management referral, or cognitive behavioral therapy."
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Old 04-27-2014
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Thanks for the answers guys. Ive found several other differences between the qbanks, in these past days
Im gonna go with uworld on this One too, cause I think they are more reliable than Kaplan.

I would always assume that conservative management goes before pharamacotherapy too
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Old 04-29-2015
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Quote:
Originally Posted by drivenby View Post
Thanks for the answers guys. Ive found several other differences between the qbanks, in these past days
Im gonna go with uworld on this One too, cause I think they are more reliable than Kaplan.

I would always assume that conservative management goes before pharamacotherapy too
Would you mention the differences between UW and Kaplan .. As i am doing Kaplan Q bank right now.
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