Despite published guidelines, fibromyalgia (FM) treatment still varies depending on physicians’ specialties, according to the findings of a study recently published Pragmatic and Observational Research.
FM is a chronic pain condition, characterized by numerous associated symptoms that include widespread pain, fatigue, sleep disturbances and dyscognition. Some symptoms may be shared with other conditions also in the FM patient.
As with many forms of chronic pain, multiple treatment approaches can be considered. Clinicians often match the appropriate treatment strategy with the needs of the individual patient.
Historically, the management of FM had largely fallen under the purview of rheumatologists. Most recently, patients have been reaching out for treatment from a wider range of health experts that include primary care physicians, psychiatrists, and neurologists.
In the study “Variations in the management of fibromyalgia by physician specialty: rheumatology versus primary care,” a team of researchers evaluated the effect of physician specialty regarding diagnosis and treatment of FM, and assessed the clinical status of patients initiating new treatment for FM.
The data was collected from the Real-World Examination of Fibromyalgia: Longitudinal Evaluation of Costs and Treatments (REFLECTIONS). The study was an observational, multicenter, real world study in which treatment occurred as part of routine care provided during the course of normal clinical practice.
Physician cohorts included 54 rheumatologists, 25 primary care physicians, and 12 physicians from a mix of practices such as psychiatry, neurology, obstetrics and gynecology.
The results showed that rheumatologists expressed higher certainty diagnosing FM compared to primary care physicians. All physicians agreed that identifying FM is their responsibility and that psychological aspects of FM are important. All also agreed that symptoms are not psychosomatic.
All also agreed that a multidisciplinary approach including pharmacological and nonpharmacological therapies is needed, although physicians were more confident prescribing medications than alternative therapies. The majority of the patients reported multiple comorbidities (other conditions), moderate to severe pain, and treatment with several drugs and nonpharmacologic treatments.
According to the research report: “All groups of physicians seemed confident in their diagnosis of FM and see management of FM as their responsibility. Rheumatologists are more likely to use the currently recommended therapies, with primary care physicians more often prescribing more traditional therapies.”
The report concluded: “With FM being categorized as more of a pain syndrome rather than a musculoskeletal disease, and as the care of patients with FM shifts from RHMs (rhueumatologists) to multiple physician specialties, examining predictors of FM treatment selection such as physician specialty may help improve FM treatment selection.”