THE FIBROMYALGIA QUANDARY OF THE LAST 2 DECADES
Fibromyalgia (FM) has courted controversy since formal recognition in the mid-1980s1–4. Ambivalence regarding the very existence of this condition has at times stimulated heated debate. As FM was initially believed to be a rheumatic complaint due to the presence of body pain and soft tissue tenderness, rheumatologists, by default, have had responsibility for the diagnosis and, often, continued management of these patients. This ownership was consolidated by the development of criteria for diagnosis of FM by the American College of Rheumatology (ACR) in 19905.
Over the last 2 decades there has been an evolution in the understanding and awareness of FM, which may affect between 2% and 4% of the population6–8. The scientific basis for FM is now firmly grounded with objective neurophysiologic evidence. FM can no longer be categorized as a rheumatic disease process, but rather is a pain syndrome centered in the nervous system9–12. It is also increasingly clear that optimal management of patients with FM requires the healthcare team to address a broad spectrum of varied complaints that go beyond a simple complaint of pain13.We therefore propose that now is the time for rheumatologists to reevaluate their responsibility for both the diagnosis and care of patients with FM.
PRIMARY CARE PHYSICIANS DEMONSTRATE IMPROVED DIAGNOSIS OF FM
This call for change for the care of FM patients seems even more plausible in light of the report by Shleyfer and colleagues in a recent issue of The Journal14. The authors have shown that family physicians can correctly diagnose FM in 70% of patients, and of particular note, other important medical conditions were not missed. This shows considerable improvement from the less satisfactory appreciation of FM by family physicians reported by this same group 10 years ago15. Their …
Address reprint requests to Dr. M-A. Fitzcharles, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada. E-mail: mary-ann.fitzcharles{at}muhc.mcgill.ca