Understanding Fibromyalgia; How Experts are Diagnosing and Treating Their Patients - Episode 20
Experts highlight current challenges in their practice treating patients with fibromyalgia (FM).
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: I'm not finding this, but I'm wondering if any of you are. Given that many of these medications are now generic, not all of them. But are there challenges in getting these medications covered by payers at this point? We heard earlier that, for instance, the Orexin Antagonists for sleep, we must often have a prior authorization done. But what about the medicines, Milnacipran? Are you seeing any issues? Duloxetine? Pregabalin? Gabapentin? Getting these drugs approved?
Kostas Botsoglou, MD: One reason why I select Gabapentin first is that I know I don't have to get it approved. It's so widely available and affordable. But if you want to transition to Pregabalin you must show–a prior authorization is required and you do have to demonstrate failure at least with a therapeutic dose of Gabapentin.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: What do you think the biggest challenges are in terms of unmet needs for our patients with fibromyalgia?
Benjamin Natelson, MD: Treatment and I guess my colleagues see patients on the severely ill end of that skewed spectrum and I'd like not to have to use an opioid so if there was anything that I could put in after I ramp up. I have this ramp up schedule, so if I didn't have to go to opioids, I'd love to have that tool.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Dr Clauw?
Daniel Clauw, MD: The problem as I see it is we need to train a new group of providers to take care of people with chronic pain. The people that hang out a shingle in the United States as pain management have usually got a one-year fellowship to put needles into people. We really need people, providers to embrace the fact that in the right settings where they can provide integrative care, where they're not out on an island taking care of individuals on their own. Where they have more of a village. They can put someone in. In those systems, these patients get better. They're a lot easier to care for. But if you're a single, individual provider, who's trying to do this on your own, good luck.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Dr Botsoglou?
Kostas Botsoglou, MD: In addition, having our primary care providers feel more comfortable and realize this doesn't have to be a specialist. This is something they see more often. They have the same tools that we have and it's something that can be easily treated rather than cycling through a variety of specialists and ultimately a delayed diagnosis, because as we mentioned, sometimes the diagnosis itself can be therapeutic for the patient.
Transcript edited for clarity.