Fibromyalgia: Physical Medicine and Rehabilitation for Fibromyalgia
by Scott Stoney, MD
Fibromyalgia is not only a difficult illness for patients who are
forced to live with chronic pain and other co-morbid conditions, it is also perplexing to
physicians who often do not have the tools necessary to feel comfortable in making an
accurate diagnosis or to prescribe a successful treatment regimen. In his discussion of
the pathophysiology of fibromyalgia, medications, and rehabilitation strategies, Dr.
Stoney highlights the usefulness of the Fibromyalgia Oswestry Pain Questionnaire as a tool
to measure pain management efficacy in this patient population.
— Rae Marie Gleason
 Physical medicine and rehabilitation (PM&R), also known as physiatry, is a
branch of medicine that aims to enhance and restore functional ability and quality of life
to those with physical impairments or disabilities. Physical medicine and rehabilitation
involves the management of disorders that alter the function and performance of the
patient. Emphasis is placed on the optimization of function through the combined use of
medications, physical modalities, physical training with therapeutic exercise, movement
and activities modification, adaptive equipments and assistive device, orthotics (braces),
prosthesis, and experiential training approaches. The major concern of the field is the
ability of the person to function optimally within the limitations placed upon them by a
disease process for which there is no known cure. The emphasis is not on the full
restoration to the pre-morbid level of function, but rather the optimization of the
quality of life for those who may not be able to achieve full restoration. A team approach
to chronic conditions is emphasized to coordinate care of the patients.
Pathophysiology of Fibromyalgia
Fibromyalgia has been acknowledged as a disease state by the AMA, the NIH, Social Security
Administration, and the American College of Rheumatology. There is a wealth of biochemical
data that both substantiates this disorder and helps providers understand its
pathophysiology.
The patient with fibromyalgia has demonstrated gray matter loss, with one year of
fibromyalgia pain equivalent to nine years of brain aging.1 Fibromyalgia is a
chronic pain disorder affecting 2-4% of the population.2 Biological and
neuroimaging studies support the hypothesis that aberrant pain processing in the central
nervous system (CNS) of fibromyalgia patients may represent an important underlying
defect.3
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— April 2010
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