Intended Audience

This program is intended for primary care physicians.

There are no prerequisites for this educational program.

Background

Fibromyalgia (FM) is estimated to affect 5 million adults in the United States. Although previously thought to be an arthritis-related condition or inflammatory musculoskeletal disease, it is now considered to be an illness that primarily involves dysregulation of the central nervous system. FM is not related to a specific identifiable cause, and numerous factors are involved.

Patients with FM typically see many providers before receiving the diagnosis. In a large Internet survey of more than 2500 individuals diagnosed with FM, the National Fibromyalgia Association found that 46% of respondents had consulted between 3 and 6 health care providers before obtaining the diagnosis, and 25% had seen more than 6 providers prior to diagnosis. Almost one-third of respondents felt that their provider did not view FM as a “very legitimate” disorder. One reason is that the main symptoms of FM, pain and fatigue, overlap with many other conditions. In addition, there are currently no generally accepted, objective diagnostic laboratory tests for FM — as a result, the diagnosis itself is still debated.

Why You Should Participate

Patients with FM need help now because symptoms can significantly affect their ability to carry out daily activities and impair their quality of life. Even though no cure exists, effective treatments are available. Rheumatologists are responsible for approximately 42% of the diagnoses of FM, but provide ongoing care for fewer than 20% of diagnosed patients. Primary care physicians diagnose a significant portion of FM patients, and experts have recommended primary care as the most appropriate specialty to assume their management. Therefore, it is important to recognize this disorder early in order to provide appropriate care and reduce unnecessary health care utilization.

In this series of 4 podcasts, Elizabeth Tracey, Director, Electronic News Media, the Johns Hopkins University School of Medicine, interviews experts about the etiology, diagnosis, and treatment of FM.

PodMed 1: Etiology
Sean Mackey, MD, PhD
Associate Professor of Anesthesia
Neuroscience and Neurology (by Courtesy)
Chief, Division of Pain Management
Stanford University

Learning Objective:
At the conclusion of this activity, the participant should be able to:

• Outline the etiology and pathophysiology of fibromyalgia

PodMed 2: Diagnosis
Roland Staud, MD
Professor of Medicine
University of Florida, Gainesville

Learning Objectives:
At the conclusion of this activity, the participant should be able to:

• Diagnose patients with FM using the 1990 and 2010 FM criteria
• Understand the pathogenesis of FM and other chronic central hypersensitivity syndromes

PodMed 3: Treatment
Lesley M. Arnold, MD
Professor of Psychiatry and Behavioral Neuroscience
University of Cincinnati College of Medicine

Learning Objectives:
At the conclusion of this activity, the participant should be able to:

• Describe pharmacologic treatment options for FM
• Discuss nonpharmacological treatments for FM

PodMed 4: Conclusions: Etiology, Diagnosis, and Treatment
Michael R. Clark, MD, MPH
Associate Professor & Director
Chronic Pain Treatment Programs
Department of Psychiatry & Behavioral Sciences
The Johns Hopkins University School of Medicine

Learning Objectives:
At the conclusion of this activity, the participant should be able to:

1. Understand the difference between the potential etiologies and pathological evidence for FM.
2. Clarify the diagnostic criteria and process for determining that a patient suffers from FM.
3. Enumerate the multiple components of a comprehensive treatment and rehabilitation plan for patients with FM.

Estimated time to complete this activity: Each podcast is approximately 15 minutes

Release Date: May 6, 2011

Expiration Date: May 6, 2012

Supported by educational grants from Forest Laboratories, Inc. and Pfizer Inc.

Faculty Disclosures

As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

Lesley M. Arnold, MD, has disclosed the following relevant financial relationships: Grants/Research Support: Eli Lilly and Company, Pfizer Inc., Cypress Bioscience, Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Forest Laboratories, Inc. Consultant: Eli Lilly and Company, Pfizer Inc., Cypress Bioscience, Inc.
Michael R. Clark, MD, MPH, has disclosed the following relevant financial relationships: Consultant: Eli Lilly and Company.
Sean Mackey, MD, has no financial relationships to disclose.
Roland Staud, MD, has disclosed the following relevant financial relationships: Grants/Research Support: Forest Pharmaceuticals, Inc., and Pfizer Inc. Consultant: Pfizer Inc.
Elizabeth Tracey has no financial relationships to disclose.

Off-Label Product Discussion

The following speakers have disclosed that their presentation will reference unlabelled/unapproved uses of drugs or products:

Dr. Arnold: Pregabalin, gabapentin, tricyclic antidepressants, sedative hypnotics, opioids

Accreditation and Registration

Accreditation Statement
The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

(Each podcast is designated for .25 AMA PRA Category 1 Credits™)

Johns Hopkins Statement of Responsibility

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this continuing medical education (CME) activity.

Disclaimer

The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.

Internet CME Policy

The Office of CME at the Johns Hopkins University School of Medicine is committed to protect the privacy of its members and customers. Johns Hopkins University School of Medicine (SOM) CME maintains its Internet site as an information resource and service for physicians, other health professionals and the public. CME at the Johns Hopkins University SOM will keep your personal and credit information confidential when you participate in a CME Internet based program. Your information will never be given to anyone outside of the Johns Hopkins University School of Medicine’s CME program. CME collects only the information necessary to provide you with the services that you request.

CME Credit

To receive credit, you must participate in the activity, complete the pre- and post-activity assessment and evaluation, and document the amount of time you spent in the activity. A CME certificate will be available online for printing upon completion of these items.

Hardware/Software Requirements

Software:
Windows 98, 2000, XP, 2003, Vista, or Windows 7 and one of the following browsers–Internet Explorer 6/7, Firefox 2/3, Mozilla 1.7 or higher, Netscape 8.1 or higher. Mac OS X 10.3 or higher and one of the following browsers–Safari, Firefox 2/3. JavaScript and cookies must be enabled. Users need to have an Adobe Flash Player plug-in on their Internet browser, if you do not have a flash player you can download it here http://get.adobe.com/flashplayer/.

Hardware:
Windows® - Intel® Pentium® II 450MHz, AMD Athlon™ 600MHz or faster processor (or equivalent) and 128MB of RAM
Macintosh- PowerPC® G3 500MHz or faster processor, Intel Core™ Duo 1.33GHz or faster processor and 128MB of RAM
Linux® -Modem processor (800MHz or faster) and 512MB of RAM, 128MB of graphics memory

Copyright © 2011 The Johns Hopkins University School of Medicine. All rights reserved

Questions

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