Generalist doctors, and even many specialists, have relatively poor knowledge of the American College of Rheumatology 1990 and 2010 fibromyalgia diagnostic criteria, according to results of a survey conducted in Canada.
"Physicians do not have adequate and homogeneous knowledge of the fibromyalgia diagnostic criteria. Approximately half of physicians did not adhere to the criteria. Poor knowledge and adherence . . . may increase diagnosis delays and misdiagnoses. Knowledge translation strategies should be implemented to address this problem," lead author Dr Dinesh Kumbhare of the University of Toronto and his coauthors write in Pain Medicine.
"I think most physicians are aware of fibromyalgia, although many still 'don't believe in it' and communicate this (lack of belief) to their patients. Even among physicians who accept the science and existence of fibromyalgia, there is lack of understanding of it, which hampers their ability to effectively communicate about it with their patients," Dr. Eric L. Matteson, a professor of medicine at Mayo Clinic College of Medicine and Science in Rochester, Minnesota, told Reuters Health by email.
"In general, the results are unsurprising and reflect the lack of knowledge about this common pain condition. Many patients who are referred to me with chronic pain problems are wrongly diagnosed with fibromyalgia or are wrongly diagnosed as not having fibromyalgia," added Dr. Matteson, who was not involved in the study.
Dr. Kumbhare and his colleagues distributed a 37-item questionnaire to a convenience sample of 284 physicians who practice in urban clinical settings and diagnose chronic pain conditions: 100 family physicians, 69 anesthesiologists, 58 physical medicine and rehabilitation specialists, 29 rheumatologists, and 28 neurologists.
The questionnaire tested the physicians’ knowledge of the 1990 fibromyalgia classification criteria and the 2010 diagnostic criteria. The researchers assessed the homogeneity of the responses and whether specialist training affected the physicians’ knowledge.
Overall, 12% of the respondents used only the 1990 criteria in their practice, 27% used the 2010 criteria, 12% used both, and 49% used no criteria. Therefore, only 51% of respondents adhered to these sets of criteria in diagnosing fibromyalgia.
Doctors with specialist training were more familiar with the criteria, but their knowledge was not comprehensive. Even physicians categorized as having the “most specialist training” had mean scores of only 55.4% for the 1990 criteria and 72.4% for the 2010 criteria.
The authors suggest that doctors and medical students learn about the criteria and updates to them – and apply the criteria in daily practice. They specifically recommend continuing medical education seminars, dropdown menus that provide fibromyalgia diagnostic criteria in electronic medical records, and online training modules on fibromyalgia diagnosis. They also say medical and residency pain curricula should offer advanced courses on chronic pain and fibromyalgia diagnosis.
Dr. Matteson agreed. "The most important aspect of the survey is awareness-building. If the findings can be brought to the attention of educators and practitioners with resultant changes in practice, then they will influence patient care," he said.
Dr. Anne Louise Oaklander, an associate professor of neurology at Harvard Medical School and a neurologist at Massachusetts General Hospital, in Boston, told Reuters Health by email that the results did not surprise her: “Fibromyalgia isn’t a disease but, rather, a term agreed on by groups of physicians to describe a loose constellation of symptoms. The criteria for inclusion and exclusion are complex and have varied over the years; plus some of the features are impractical or difficult to apply or contradict medical experience."
"A minor weakness is that they assessed knowledge of earlier versions of the American College of Rheumatology diagnostic criteria (1990 and 2010) but not the latest changes to them in 2011 and 2016, which are the ones that doctors ideally should be using," said Dr. Oaklander, who was not involved in the study.
"Also, they included medical specialists other than rheumatologists, and I don’t think it’s realistic to expect doctors from other medical specialties to know the details developed by rheumatologists to guide rheumatologists," she concluded.
Dr. Kumbhare did not respond to requests for comment.