Survey of physician experiences and perceptions about the diagnosis and treatment of fibromyalgia

Serge Perrot,Anna Ginovker,Ernest Choy,Erich Kramer,Danielle Petersel

doi:10.1186/1472-6963-12-356

Abstract

BackgroundFibromyalgia (FM) is a condition characterized by widespread pain and is estimated to affect 0.5-5% of the general population. Historically, it has been classified as a rheumatologic disorder, but patients consult physicians from a variety of specialties in seeking diagnosis and ultimately treatment. Patients report considerable delay in receiving a diagnosis after initial presentation, suggesting diagnosis and management of FM might be a challenge to physicians.MethodsA questionnaire survey of 1622 physicians in six European countries, Mexico and South Korea was conducted. Specialties surveyed included primary care physicians (PCPs; n=809) and equal numbers of rheumatologists, neurologists, psychiatrists and pain specialists.ResultsThe sample included experienced doctors, with an expected clinical caseload for their specialty. Most (>80%) had seen a patient with FM in the last 2 years. Overall, 53% of physicians reported difficulty with diagnosing FM, 54% reported their training in FM was inadequate, and 32% considered themselves not knowledgeable about FM. Awareness of American College of Rheumatology classification criteria ranged from 32% for psychiatrists to 83% for rheumatologists. Sixty-four percent agreed patients found it difficult to communicate FM symptoms, and 79% said they needed to spend more time to identify FM. Thirty-eight percent were not confident in recognizing the symptoms of FM, and 48% were not confident in differentiating FM from conditions with similar symptoms. Thirty-seven percent were not confident developing an FM treatment plan, and 37% were not confident managing FM patients long-term. In general, rheumatologists reported least difficulties/greatest confidence, and PCPs and psychiatrists reported greatest difficulties/least confidence.ConclusionsDiagnosis and managing FM is challenging for physicians, especially PCPs and psychiatrists, but other specialties, including rheumatologists, also express difficulties. Improved training in FM and initiatives to improve patient-doctor communication are needed and may help the management of this condition.

Highlights

Fibromyalgia (FM) is a condition characterized by widespread pain and is estimated to affect 0.5-5% of the general population
In a survey of 800 FM patients in six European countries, Mexico and South Korea, patients most commonly presented to primary care physicians (PCPs), and to neurologists and psychiatrists [9]
Primary care physicians saw the greatest number of patients per month, significantly exceeding all other specialties

Summary

Introduction

Fibromyalgia (FM) is a condition characterized by widespread pain and is estimated to affect 0.5-5% of the general population It has been classified as a rheumatologic disorder, but patients consult physicians from a variety of specialties in seeking diagnosis and treatment. While recommendations for FM diagnosis (the use of ACR criteria and the Fibromyalgia Impact Questionnaire) and treatment (aerobic exercise, cognitive behavioural therapy, amitriptyline, duloxetine, milnacipran, pregabalin) exist, these recommendations have yet to be adopted into a standard diagnostic or treatment algorithm [10] This may be reflected in the significant differences that have been reported, in terms of FM diagnostic and treatment patterns, by physicians of different specialties in the United States [11]

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