Who Manages Fibromyalgia Patients?
Medscape: How familiar and/or comfortable do you think primary care clinicians are with making an FM diagnosis? Or do you feel it is more the domain of pain specialists and rheumatologists?
Dr Clauw: I think practicing primary care physicians (PCPs) are much more comfortable in both diagnosing and treating FM than they once were. If they are not comfortable, most subspecialists are very willing to see a patient a single time and confirm that FM is the correct diagnosis— and it is reasonable to send patients to whatever subspecialist they think can best make that distinction given the patient's predominant symptoms (eg, rheumatologist if the presentation is primarily musculoskeletal; neurologist if the symptoms mimic multiple sclerosis).
Regarding treatment, subspecialists often have nothing additional to offer that PCPs cannot do, which is why most of us encourage PCPs to treat these patients themselves. Otherwise the patients will often get procedures that are not helpful or get put on classes of drugs (ie, opioids) that are not helpful.
Dr Mease: I suspect that PCPs vary considerably in their comfort and confidence in diagnosing and treating FM. I would agree with Dan that more and more of the PCPs I speak with or lecture to are growing savvier about understanding the neuroscience behind FM, willing to have less stigma about considering the diagnosis, and garnering experience with use of nonnarcotic neuromodulatory medicines and nonpharmacologic approaches to treating FM.
However, there are broad swaths of PCPs who have not become educated about our current understanding of the pathogenesis of FM, are clueless about current treatment approaches, and/or maintain a generally negative attitude toward anything related to FM. This is also true for some of the subspecialists in rheumatology and neurology, so you cannot always count on a considerate evaluation from these subspecialists.
I don't think it is simply a matter of PCP vs subspecialist but rather a matter of having enough clinicians who have become educated and experienced with treatment potential to be willing to evaluate and treat FM patients. The assessment and treatment are not complicated or risky, so they can be readily accomplished by a savvy PCP.
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Cite this: Daniel J. Clauw, Philip J. Mease, Bret S. Stetka. Fibromyalgia: The Latest in Diagnosis and Care - Medscape - Sep 17, 2014.