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Let's get honest about fibromyalgia.

It's time for rheumatologists to recognize and act on the fact that what we have been doing so far to manage fibromyalgia patients has not worked well. We are not the best equipped to care for patients with this complex disorder.

Fibromyalgia requires a multidisciplinary, biopsychosocial approach involving not just physicians, but mental health professionals and physical therapists. The therapeutic approach should be multifaceted, including both a pharmacologic approach and nonpharmacologic treatments such as exercise and meditation, and promotion of self-efficacy so that patients feel in control of their illness. These approaches are central to the successful self-management of a condition such as fibromyalgia, and patients need to be educated about the role of psychological factors.

Because of the social and behavioral factors associated with fibromyalgia, family physicians are in the best position to oversee the care of these patients. It is the family physician who is most likely to detect family stressors and developmental problems, such as childhood abuse, that can be precursors to fibromyalgia.

That's not to say that rheumatologists don't have a key role to play in providing at least a one-time consultation to confirm the diagnosis. Of all the medical specialties, we have the most experience in diagnosing fibromyalgia and treating chronic pain. And we are uniquely positioned to determine if patients with symptoms of fibromyalgia are actually suffering from a rheumatic disease with similar symptoms.

But taking on the role of primary caregivers for these patients doesn't work anymore.

There are too many people with fibromyalgia to be seen by the 4,000 or so rheumatologists in the United States.

In addition, the number of rheumatologists in this country is in decline. Over time, there will be even fewer rheumatologists to meet the complex needs of these patients.

When rheumatologists do see fibromyalgia patients, we need to ask the tough questions: "Did you experience any physical, sexual, or emotional abuse?" and "What kind of stress do you have in your life right now?" We also need to be prepared to refer patients appropriately.

Addressing these issues is essential to understanding the whole patient and determining the underlying factors of the patient's disease.

Dr. JOHN B. WINFIELD is professor of medicine at the University of North Carolina, Chapel Hill.
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Title Annotation:Guest Editorial
Author:Winfield, John B.
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Mar 1, 2004
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