Publication Date: 2024
Journal: Medicine
Référence de la revue Agarwal, A., Emary, P.C., et al. (2024). Physicians’ knowledge, attitudes, and practices regarding fibromyalgia: A systematic review and meta-analysis of cross-sectional studies. Medicine, 103(31), e39109. https://doi.org/10.1097/MD.0000000000039109

Contexte :

Previous studies show provider stigma and inadequate pain management are common reasons for frustration amongst fibromyalgia patients.

Les médecins ne s'accordent pas toujours sur la façon de traiter la fibromyalgie (FM). Les traitements qu'ils recommandent sont très variés, et ce qui fonctionne pour une personne peut ne pas fonctionner pour une autre. Certains traitements, comme l'exercice physique, sont efficaces pour de nombreuses personnes, mais d'autres, comme les opioïdes ou les thérapies alternatives, sont rarement recommandés. De plus, de nombreux médecins ne suivent pas de directives claires concernant la FM, ce qui peut compliquer l'accès à des soins réguliers pour les patients. Cette étude a examiné la perception des médecins concernant la FM, leur traitement et les difficultés rencontrées par les patients lorsqu'ils cherchent de l'aide.

Who Was Studied:

This research reviewed 21 studies with data from 8,904 doctors worldwide.

• 24% of studies were in the U.S., 19% in Canada, and others came from countries like China, Spain, and Iran.
• The participants included general practitioners (GPs), rheumatologists, and physicians in training, with a mix of experience levels and specialties.

How the Study was Conducted:

This was a systematic review and meta-analysis of studies, dating back to 1997, looking at physician’s knowledge, attitudes and practices about fibromyalgia - not comparing what treatments work the best.

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Key Findings:

• Doctors Recommend Many Different Treatments:
  1. Non-opioid painkillers (67%) et antidepressants (67%) were among the most commonly recommended medications for FM
  2. NSAIDs (like ibuprofen) were supported by 49% of doctors
  3. Anticonvulsant medications (e.g., pregabalin) were recommended by 33% of doctors, with higher endorsement in high-income countries
  4. Very few doctors recommended corticosteroids (22%), opioids (7%)
  5. Exercise was a popular non-drug treatment (73% of doctors). Walking or swimming was recommended by two-thirdsof doctors and aerobics by 22-50% of doctors
  6. Alternative therapies likehomeopathy, massage, or chiropractic care were recommended  (3%–21%)
• Doctors Use Different Methods to Diagnose FM:
  • Only 49% of doctors know the official criteria for diagnosing FM (such as the American College of Rheumatology). Rheumatologists were more familiar with these criteria (69%) compared to GPs (38%)
  • Some doctors don’t use these guidelines at all, which leads to differences in how FM is identified and treated (65% use the criteria to diagnose)
• Doctors Find FM Patients Hard to Treat:
  • 76% of doctors said FM patients take too much time and are challenging to manage. They described patients as overly focused on their illness and looking for answers that medicine can’t always provide
  • 50% of Canadian rheumatologists may refuse referrals for FM patients, believing GPs should manage the condition. However, many GPs feel that specialists like rheumatologists should handle FM care.
• Disagreement About FM’s Cause:
  • Doctors are divided on whether FM is primarily psychological or biological. 51% view it as a psychosocial condition (ranged from 31-72%), this understanding can influence how they approach treatment.
  • 84% of doctors consider fibromyalgia as a real medical condition. In other words, most knew that fibromyalgia is real.

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Limitations:

The publication dates are as far back as 1997.  Findings from older studies were not compared to findings from newer studies to see how provider perceptions may have changed over the years. This may be because the studies were not carried out  in the same way.

Some of the percent estimates from combining studies had inconsistencies that the researchers could not explain, making them less confident in the exact findings (i.e., percentages)

The article only reviewed studies that were published in English. The article’s summary might not apply to perceptions of francophone healthcare providers.

Discussions/ Conclusions

This study highlights serious gaps in how FM is understood and treated by healthcare providers. Many doctors lack up-to-date knowledge or follow inconsistent practices, making it harder for patients to get reliable, effective care. Frustration among doctors and stigma toward FM patients only add to these challenges, with some physicians even refusing to see FM patients.

If you have FM, advocating for yourself and finding a doctor and other healthcare providers with expertise in FM care is crucial. There is an urgent need for better education and updated guidelines to ensure all FM patients receive the compassionate and effective care they deserve.

Article summarized by FAC Research Committee  2025 For more information consult the original article https://doi.org/10.1097/MD.0000000000039109