At present, there is no specific treatment for FM, partly because of the lack of understanding of its aetiology and pathogenesis. Self-management based programs have been proposed to help the patients cope with their symptoms and improve their quality of life. These programs mainly use information, physical conditioning, and cognitive-behavioural techniques.
Information in chronic pain patients has been emphasised as an important component as a well-informed patient is an essential member of a successful chronic illness management team. Acknowledging FM patients’ pain and suffering is also a key point in these programs.
FM patients have been shown to have functional impairment which include their ability to perform daily activities. They have decreased muscle strength and endurance, and low levels of physical fitness. Exercise programs are various and may include range-of-motion exercises, cycling, walking, swimming, specific muscular reinforcement, etc. Pool exercises have been used in various programs, as part of the training schedule or as a warming-down/relaxation procedure after an exercise session. Along with walking, warm water activities are best tolerated, but there are no contra-indications to endurance activities.
Compliance has been described as one of the major problems in exercise programs for FM patients. An inactive lifestyle is associated with poor physical fitness, and pain may further discourage participation in physical activities. If exercises are started in the deconditioned body, the unaccustomed physical activity may lead to more complaints and to further avoidance of physical activity. A vicious circle leading to less and less activity may ensue. This vicious circle is probably one of the reasons of low rates of volunteering, poor compliance with the program and/or program follow-up prescriptions, or drop-outs.
Self-management based programs will be illustrated with examples drawn from the literature and from our experience in Geneva.
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