Perceptions of Fibromyalgia Syndrome FMS in Primary Care Practice Terence W. Starz, Molly T. Vogt, F

1
Perceptions of Fibromyalgia Syndrome (FMS) in
Primary Care Practice Terence W. Starz, Molly
T. Vogt, Francis Solano, Margaret Moore
University of Pittsburgh Medical Center,
Pittsburgh, PA

Results
Introduction

• Demographics
• 56 internists, 42 family practitioners
• in practice for an average of 20.7 years ( range
  4-46 yrs.)
• majority (79) practiced in a group setting
• Beliefs
• 78 believe that FMS is a distinct clinical
  entity
• 85 believe that FMS has both psychological and
  
• medical components
• Diagnosis
• 92 aware of ACR criteria
• 56 routinely use the criteria in practice
• Lab and Imaging studies ordered
• 90 thyroid function studies
• 82 complete metabolic profile
• Rheumatologic testing - rheumatoid factor (76),
  ANA
• (76), ESR (87), CRP (39), HLA-B27(2), CCP
  (6)

FMS occurs in 56 of adults seen by general
internists and family practice physicians.
However, although the ACR developed criteria for
the diagnosis of FMS in 1990, clinicians continue
to debate the appropriate diagnostic criteria and
management for this syndrome. This study
describes the perceptions of PCPs about FMS, its
impact on their practice and their specialty
referral patterns.

• Non-pharmacologic interventions used by 98
• 95 exercise, 91 physical therapy, 66
  education
• 37 tender point injections, 29 cognitive
  behavioral therapy
• 25 chiropractic, 18 occupational therapy, 17
  TENS
• 12 acupuncture, 7 herbals.
• Referral patterns
• 93 use rheumatologists for evaluation and
  management
• referral
• 46 pain specialists, 24 physiatrists, 22
  psychologists,
• 21 psychiatrists
• Impact on practice
• 33 report that more than 5 of their patients
  have FMS
• 87 report that FMS patients require more time
  than typical
• patients

Methods
A questionnaire was sent via email or fax to
183 PCPs in southwestern Pennsylvania. 87
PCPs (48) responded to the survey.
Information was obtained on the perceptions of
PCPs  about the diagnosis and management of FMS
    - was it a medical or psychological
condition    - were the 1990 ACR criteria used
in diagnosis    - were laboratory and imaging
studies ordered - treatments used - the
impact of FMS patients on clinical practice    
- office time spent with FMS patients -
referral patterns. Analysis was performed
using descriptive statistics and chi-square
test for comparisons.
Conclusions
Although PCPs believe that FMS is a distinct
clinical entity, only about half use the ACR
fibromyalgia criteria for diagnosis.
Rheumatologic testing is commonly utilized. Most
PCPs believe that rheumatologists should be
actively involved in the evaluation and
management of FMS patients.