Primary Care Physicians are inundated with Fibromyalgia and Chronic Fatigue cases. In the current climate of managed care, an ill patient receives an average of 10-15 minutes of attention from the well-meaning doctor, and leaves with a prescription or a referral. A person with Fibro often gets bounced around to a number of specialists, including rheumatologists, neurologists and orthopedists before returning to the PCP without answers or solutions. This causes a great deal of frustration for both doctor and patient, and that frustration often leads to less attentive care rather than more.
Many physicians are now prepared to offer a diagnosis of Fibromyalgia based on the presence of pain points, following a reasonable diagnostic process of elimination of other conditions. This does represent progress as compared to ten years ago, when there was less understanding of the condition and therefore, less compassionate, less comprehensive care. However, there has not been as much progress in the area of management of care. People with Fibro require a certain touch, and that is often outside of the availability and skill set of the PCP.
According to the most current information available, the largest number of people with Fibro benefit the most from a multimodal treatment approach. Some combination of medications, alternative treatments, nutrition and exercise seems to offer the most consistent relief for chronic pain and other symptoms of Fibro, and success of these treatments is augmented significantly by the addition of cognitive behavioural therapy. However, in most cases the primary care physician is not in a position to manage such an array of treatments and has neither the time nor attention to manage the needs of these patients effectively.
As an alternative, the job of management could be transferred to the cognitive behavioural therapist, who is not only more versed in treatments available, but is uniquely suited to assist the patient in managing day to day functioning, and this greatly increases the likelihood the patient will comply with the treatments recommended by the physician and/or psychiatrist.
Fibromyalgia is painful and debilitating. Effective treatment requires innovation, focus and perseverance, and we can get there.