Understanding Fibromyalgia; How Experts are Diagnosing and Treating Their Patients - Episode 9

Who is Diagnosing FM

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Experts discuss which providers often diagnose fibromyalgia (FM) and how the burden of care has changed in recent years.


Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Who do you think makes the diagnosis of fibromyalgia most often? Do you think it's rheumatology? Do you think it's pain neurology, physiatry, primary care? What's your thought on that?

Benjamin Natelson, MD: Must be primary care. I'm just going to say for the FDA approved three drugs for the treatment of fibromyalgia it probably was different. The primary care doctor didn't even want to know about these patients, but as soon as their FDA approved drugs, then the primary care doctor starts nodding his or her head and says, I can help these patients. And things are different. That it's a very common syndrome in 5 or 6% of America. And they're not being helped by we neurologists or rheumatologists as much as the primary care doctor.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: I will tell you in my community the rheumatologists are really limiting who they will take on for patients just because there are not enough of them and they really need to focus on the more chronic inflammatory disorders, rheumatoid, psoriatic arthritis, et cetera. So, for me, a lot of this falls back into our lap because we are the ones who are seeing these patients over time. Any other thoughts on this?

Kostas Botsoglou, MD: I agree with you, Wendy. It's access. There are very few rheumatologists in my metropolitan area, and many since COVID have been required. So, they're not going to make their way into a rheumatologist practice as quickly as they can make it to a primary care.

Daniel Clauw, MD: And the rheumatologists are not trained to take care of this group of patients, they're trained to take care of people with autoimmune disease. And there is a workforce issue with rheumatologists. There's absolutely not enough rheumatologists to take care of people with bad lupus and bad rheumatoid arthritis, and that's where they should be. At most the rheumatologists should be seeing these people once and making sure they don't have autoimmune disease. We shouldn't expect that they are the ones that will be, it's just too common.

Benjamin Natelson, MD: And again, the rheumatologist is not a pain manager. He or she is an inflammation manager. I would like to jump in because we've been lumping headache and migraine with these disorders and with the discovery of these calcitonin gene related treatments, we've made real giant steps in treating these vascular headaches. We have to keep an open mind about ultimately finding pathophysiological ways to differentiate one patient with one set of symptoms from another, and hopefully will lead to different treatments.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: As we're finding the different neurotransmitters that are involved with different types of pain syndromes, look at nerve growth factor in how we're coming along with that in terms of osteoarthritis. So, I think that the future is very, very bright. And this provides a really nice segue, unless you have any further comments about the diagnosis section, I'd love to move us on now to treatment. Any comments from any of you before we move on? The only one thing I do want to end this section with is that there are studies that show that one of the most important things that we can do for our patients with fibromyalgia is to give them a diagnosis.

Benjamin Natelson, MD: That's true.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Once they're told that this is what is going on. They then believe that people believe them, and that it's no longer in their head. I've had so many patients say thank you. It makes me believe that you believe me. And I think that's important.

Daniel Clauw, MD: And another thing is that a few studies that have looked at that show that there's a decrease in healthcare utilization when you appropriately diagnose someone with fibromyalgia because they stop getting all these referrals and all this unnecessary diagnostic testing. So several studies have shown that there's that benefit as well, not just that the patient will often say, this is the best day of my life when you finally are the one that tell them what they have.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: I agree with you.

Transcript edited for clarity.