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55% of rheumatologists in Ontario think fibromyalgia is psychosomatic; 71% don’t think rheumies should manage it

  [ 151 votes ]   [ 5 Comments ] • May 4, 2012

Should rheumatologists retain ownership of fibromyalgia? A survey of Ontario [Canada] rheumatologists
– Source: Clinical Rheumatology, May 2, 2012

By S Ghazan-Shahi, et al.

[Note: "The issues are now on the table," Margaret Parlor, president of Canada's National ME/FM Action Network ( commented on Friday, May 4. She notes that these views likely represent those of physicians in other provinces, and given that fibromyalgia patients "already have a high level of unmet needs," the possibility of current services being withdrawn without others to replace them is a serious issue indeed.]

Fibromyalgia is a controversial widespread chronic pain disorder that includes a wide constellation of somatic and emotional symptoms. This study surveyed the opinion of Ontario [Canada] rheumatologists with respect to their beliefs about the nature and management of fibromyalgia.

A key objective was to ascertain if rheumatologists should continue to be the main care providers for these patients.

A survey comprising 13 questions was sent electronically to all 150 Ontario rheumatologists. The questionnaire was designed to obtain:

• Demographic data,

• As well as opinions regarding different aspects of fibromyalgia.

Data were analyzed descriptively, and comparisons were made using chi-square tests. A total of 80 respondents completed our survey for a completion rate of 53%. The majority had completed their training in Canada (85%) and had been practising for more than 15 years (50%).

Key findings were:

1. 71% believe that rheumatologists should not retain ownership of fibromyalgia,

2. 55% believe that fibromyalgia is primarily a psychosomatic illness as opposed to a physical illness,

3. 89% believe that the family physician should be the main care provider for these patients,

4. Rheumatologists who consider fibromyalgia to be a physical illness were also significantly more likely to believe that rheumatologists should retain ownership of this disease (p=0.023) and were more likely to continue managing these patients in their practice (p=0.011).

The majority of Ontario rheumatologists do not wish to retain ownership of fibromyalgia. However, most of them continue to manage these patients, even though they believe that the family physician should be the main care provider for patients with fibromyalgia.

Rheumatologists may be providing care to these patients primarily because this care is not available to them from their primary care physicians.

[Note: A free access editorial commentary on this report - "Should Rheumatologists Retain Ownership of Fibromyalgia?" - notes that primary care doctors in general are getting pretty good at diagnosing fibromyalgia (average 70% correct), leaving 30% of cases without proper diagnosis. And PCs generally can't manage FM effectively. What's needed, in their opinion, is a drive to educate "treating physicians regarding differential diagnosis of diffuse pain syndromes, awareness of confounding conditions, and appreciation of treatment options, which should be tailored to individual patient needs."]

Source: Clinical Rheumatology, May 2, 2012. PMID:22547393, by Ghazan-Shahi S, Towheed T, Hopman W. Internal Medicine, Queen’s University, Kingston, Canada. [Email]

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Article Comments Post a Comment

What you THINK you know...
Posted by: greybeh
May 7, 2012
I was diagnosed with fibromyalgia in 2007 after years of struggling. In 2008, I had a sleep study and did not have (significant) apneas. But last year, I reluctantly agreed to a retest... thought I had been down that road. I got a sleep apnea diagnosis. I have been CPAP compliant since July 2011 and my roving nerve pain is gone, some daytime fatigue remains. Mom has a fibromyalgia diagnosis and has osteoarthritis all through her. She had an emergency laminectomy (a month after mri). She has sleep apnea (recently diagnosed).

Point being: something is going on that is REAL. When Moldofsky took healthy folks and deprived them of sleep (1970s), they developed fibromyalgia-like symptoms.

I feel some sleep problem is central in this... be it apnea, other chronic pain issue disrupting sleep... something. I don't believe it is a coincidence that folks with fibromyalgia tend to have multiple health issues.

Just because it is not well-understood does not mean it is not real. These folks are losing their quality of life. Are you there to help or be aloof? Please consider what I have to say.
Reply Reply

Who should manage Fibromyalgia
Posted by: Boodle
May 9, 2012
Why aren't neurologists the obvious choice? FM is about pain nerve endings and brain signals gone awry. That is most certainly more a neurological problem than a rheumatoid one.
Reply Reply

RE: "Why aren't neurologists the obvious choice?"
Posted by: mikiem
May 18, 2012
"Why aren't neurologists the obvious choice? FM is about pain nerve endings and brain signals gone awry. That is most certainly more a neurological problem than a rheumatoid one."

My **Guess** is rheumatologists got stuck with us because they deal with pain, & not much else 'bout FMS was known. Assuming they remember their regular med training [I know, big assumption], they should I'd imagine be as capable as the average GP. That said, IMO it's more about being willing to actually give decent care -- personally I wouldn't care if the doc was a podiatrist if s/he provided that care. I don't expect my doc to do the research -- just be aware of it & willing to consider the treatments etc.


Posted by: JewelRA
May 9, 2012
The family physician?? Seriously?? If fibromyalgia were *indeed* a psychosomatic illness, do they think a primary care doctor would be competent and/or have the time to deal with it? It find this very discouraging and angering, actually.

I have also found it to be true with my experience with the 2 rheumatologists I have had. They are excellent at treating my juvenile arthrtis, but do not believe in fibromyalgia. They say I am "just depressed". What absurdity! I am thankful I have found help from that VERY different kind of pain from other professionals.

I agree that neurologists should be involved, and possibly endocrinologists, if they could ever stop believing that all they have to treat is diabetes. But I guess that's where the money is.
Reply Reply

IMO whomever is willing to give care should be allowed
Posted by: mikiem
May 18, 2012
I've had terrible, Terrible experiences with specialists in different fields of medicine -- they've truly been equal opportunity offenders -- but the few that have actually tried to help weren't in the more expected disciplines. Years ago a Pulmonary specialist, who'd been called in on a consult during a bout of pneumonia, turned out to be Really great, & was the doc directly responsible for the diagnosis of CFS/ME - FMS... he went out of his way to learn, contacting the CDC etc. The Neurologist that called him in for the original consult OTOH could fill the starring role in a horror movie. Coughing brought on what appeared to be seizures - the ER assigned me to the neurologist - during an EEG I went into very severe seizure-type behavior (causing lots of bruising etc.) - he said according to the EEG it wasn't a seizure so not his problem & walked out. Of course I was still bouncing around, injuring myself -- later that day I lost my front teeth to the bed rail -- and I had to fight with the insurance company for 6 months afterward since this neurologist told them it was completely psychosomatic & they shouldn't pay a dime.
Reply Reply

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