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Why is the management of fibromyalgia syndrome so difficult for rheumatologists?

Nature Clinical Practice Rheumatology volume 3, pages 480–481 (2007)Cite this article

Many rheumatologists and other rheumatology health professionals find the management of patients with fibromyalgia syndrome (FMS) difficult. Whether or not rheumatologists should have a role in the diagnosis and management of FMS patients has been a subject of vigorous debate.1

Why is FMS viewed by clinicians differently from other rheumatic diseases that are also characterized by chronic musculoskeletal pain and fatigue, including rheumatoid arthritis and systemic lupus erythematosus? Most rheumatologists have little formal training in neurobiology or pain management, and many view themselves as clinical immunologists rather than specialists in musculoskeletal medicine. We are, therefore, most comfortable treating conditions where we understand the immune-inflammatory pathophysiology involved, we understand the mechanisms of the pharmacotherapies we utilize, and a beneficial outcome is expected from our interventions. Another factor is that primary care physicians are uncomfortable with diagnosis and management of myofascial pain or FMS.2 The demand generated by physicians referring FMS patients to rheumatologists is, therefore, too high, leading to long waiting times for new patients. Therefore, rheumatologists must continue to educate colleagues in primary care regarding the differential diagnosis of widespread musculoskeletal pain, and provide a reasonable strategy that can be employed to accurately diagnose FMS in the clinic. Avoiding negative interactions between patients with FMS and health care providers by providing firm diagnosis and information about the condition has been shown to benefit patients, and there is no evidence that 'labeling' patients with FMS leads to adverse effects.3

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Authors and Affiliations

  1. E Scarbrough is a nurse practitioner and LJ Crofford is the Gloria W Singletary Professor of Internal Medicine, both at the University of Kentucky in Lexington, KY, USA.,

    Elizabeth Scarbrough & Leslie J Crofford

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  1. Elizabeth Scarbrough
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  2. Leslie J Crofford
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Correspondence to Leslie J Crofford.

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Competing interests

Dr Leslie J Crofford is a Consultant for and has received grants/research support from Pfizer, Lilly, Wyeth and Allergen.

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Scarbrough, E., Crofford, L. Why is the management of fibromyalgia syndrome so difficult for rheumatologists?. Nat Rev Rheumatol 3, 480–481 (2007). https://doi.org/10.1038/ncprheum0564

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