Understanding Fibromyalgia; How Experts are Diagnosing and Treating Their Patients - Episode 21
Experts conclude their discussion emphasizing the importance of integrative care and how providers can improve outcomes for their patients with fibromyalgia (FM).
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: In our last couple of questions, gentlemen, how can we, me as a primary care provider, and you, as my specialty colleagues- how can we work together, do you think, to help improve the care of these patients with fibro?
Kostas Botsoglou, MD: Have a full network of occupational therapists, physical therapists, mental health, in addition to some specialists in neurology and pain management.
Daniel Clauw, MD: And we need to encourage our third party payers to more broadly reimburse for these integrative therapies. It's so much easier to take care of someone with fibromyalgia when, again, they're getting cognitive behavioral therapy for insomnia and they're getting a little bit of acupressure and there's other providers and other people attending to them, and the evidence base for these therapies has really increased to the point now that they really should be broadly approved for almost any type of chronic pain.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: And I would just add that all 11 nurse practitioners that work for me in my clinic, we read every note that you send in to us from the specialty, because we all learn a lot from the way you have set the bar and the education that you do in your consult notes, I just think that's just really important to keep up setting that bar with–because you have access to some of that latest information on the latest guidelines and treatments. As we're wrapping up tonight because our time has come to end this. This conversation has been so incredibly rich and informative. I've learned so much from all of you tonight and I want to thank you. But before we conclude this program, I'd like to ask each one of you to issue just a final thought that you have for our audience tonight. Dr Botsoglou, can you go first for us?
Kostas Botsoglou, MD: I just would like to share that this is a disease that is primarily seen in the primary care setting and with a multi-specialty approach and using modalities like aqua therapy, physical therapy, occupational therapy, in addition to pharmacologic therapy, we will be able to identify and treat these patients earlier and lead to less disease and morbidity.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Dr Clauw?
Daniel Clauw, MD: Yes, just to segue, I really think one of the biggest problems of taking care of individuals with conditions like fibromyalgia, is we wait too long before we diagnose and start treating them. If we waited seven to eight years to take care of–start treating rheumatoid arthritis, those people wouldn't have any viable joints left or gout or something like that or heart disease, so I think that that long wait–especially people that are taking care of adolescents and individuals in their 20's, you can see fibromyalgia coming when these people start having these different pain conditions in different areas of their body. When that happens, these people should be aggressively treated then, rather than ignored and acted as if there is nothing wrong with them.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Thank you. Dr Natelson?
Benjamin Natelson, MD: Again, like you pointed out earlier, giving the patient the diagnosis and establishing a good doctor-patient relation with good rapport leads to improved quality of life in and of itself. And then, putting the patient on the same page with you in terms of treatment and expectation, I think we can promise we will help them. But as you pointed out, Wendy, we're not going to be able to cure them. But if we emphasize that we can help them and they can do better and they can help themselves with gentle physical conditioning and some of the other things that were mentioned, which are non-medical, that's our job as doctors.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: I agree, and I would just like to add that having a relationship with a primary care provider or with a specialist who believes that there truly is something wrong. As I often say to my patients, just because we don't have a lab test to diagnosis it or an imaging study to do, doesn't mean that this doesn't exist and so, giving them that diagnosis and forming a partnership with them, but not just focusing on pain, but also focusing on sleep and function can go a long way to improving their quality of life. It's been such a great evening and I thank you for watching this peer exchange. If you enjoyed the content, please subscribe to our newsletters to receive upcoming peer exchanges and other great content right in your inbox. Good night and goodbye for now.
Transcript edited for clarity.