Canadian rheumatologists believe that therapies currently available to treat fibromyalgia largely fail to manage symptoms, and new diagnosis and treatment guidelines are needed to improve patient care, a new survey found.
The findings were reported in a study titled, “Attitudes Toward and Management of Fibromyalgia: A National Survey of Canadian Rheumatologists and Critical Appraisal of Guidelines,” published in the Journal of Clinical Rheumatology.
Fibromyalgia is characterized by chronic, widespread pain that can severely affect a patient’s quality of life. Clinical management of the disease is challenging, with many patients reporting no significant improvements, even when monitored at specialized rheumatology centers.
Recent discoveries have shown that fibromyalgia may be caused by complex mechanisms that are separate from musculoskeletal processes. Therefore, recent guidelines suggest that patients should be managed by primary care physicians without the need for rheumatology specialists.
“The aim of this study was to explore management strategies and attitudes of Canadian rheumatologists toward fibromyalgia and concordance with guideline recommendations,” researchers wrote.
The team conducted a nationwide cross-sectional survey that was completed by 140 rheumatologists from the Canadian Rheumatology Association. Nearly all of the physicians (98%) reported having attended to patients with either primary or secondary fibromyalgia.
The survey found that 80% of responding rheumatologists believe that fibromyalgia is a useful clinical diagnosis. However, not all agreed on the fundamentals and consequences of the disease, as only 54% said that fibromyalgia is an objectively defined condition. Most respondents — 79% — said a diagnosis is useful in guiding clinical management.
Rheumatologists also are divided on whether fibromyalgia is a psychosocial condition, with 31% agreeing and 43% disagreeing.
Contrary to guidelines, 61% said the evaluation of tender points is a useful tool for diagnosis, and only 42% said effective therapies exist.
The survey also showed that most Canadian rheumatologists manage their fibromyalgia patients with education, exercise therapy, antidepressants, and non-narcotic analgesic — all strategies that are in accordance with guidelines. However, more than half believed that these strategies are ineffective.
“Canadian rheumatologists largely do not provide primary care for fibromyalgia,” the researchers wrote. “Most adhere to recommendations by the 2012 Canadian Guidelines for management of fibromyalgia, but few endorse these interventions as effective, and there are important limitations associated with these guidelines.”
The team believes that additional studies are needed to address the disconnect between clinical practice and perceived treatment effectiveness, as well as an update of the 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia.