“I have pain all over my body” is a challenging response after you’ve asked a new patient what brings them in for their visit. You immediately suspect that this patient has fibromyalgia.
The prevalence of fibromyalgia in the U.S. is 5 million people, and it is among the most common conditions in many rheumatology practices. Data from the Rheumatology Informatics System for Effectiveness (RISE) Registry indicates that 21% of registry patients have a diagnosis of fibromyalgia.1
Factors to Note
Approaches to patients with different rheumatic diseases are not the same. For example, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) typically have objective manifestations, such as joint swelling, rash and abnormal laboratory or other test results. Why is it that patients with fibromyalgia can be more challenging for healthcare professionals?
Fibromyalgia patients may have no observable clinical findings and the tests may be normal. These patients typically present with chronic widespread musculoskeletal pain, along with a variety of other symptoms, including sleep disorders, fatigue, environmental sensitivities and autonomic manifestations, such as irritable bowel syndrome, headaches and palpitations.
In addition, fibromyalgia patients usually have emotional factors you need to be prepared to contend with, such as frustration, anger and despair. Often, patients have seen multiple healthcare professionals and have had significant diagnostic testing without a definite diagnosis being made. Fibromyalgia patients frequently report being told that their problems are “all in their head.”
Rheumatologists and rheumatology health professionals need to keep in mind that it is not inappropriate for an individual to be upset if they are having daily pain and other symptoms that profoundly affect their lives, their activities and interpersonal relationships. Further, patients are frequently not certain what their diagnosis is and what they should do about it.
Visit No. 1
When evaluating a patient with fibromyalgia for the first time, there is a defined set of steps that you can begin with to help have a successful visit. Patients are often not clear about their expectations, what should go on during the visit and how to establish a relationship with their physician and other healthcare professionals. Your goals for the visit are to establish a rapport with the patient, to develop their confidence in you, to determine the diagnosis and to actively engage them in diagnostic and treatment measures. Remember that the evaluation is not only yours of the patient, but also their evaluation of you, which can have a profound and lasting impact on the success of your relationship.