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Attitudes Toward and Management of Fibromyalgia

A National Survey of Canadian Rheumatologists and Critical Appraisal of Guidelines

Agarwal, Arnav BHSC*†‡; Oparin, Yvgeniy BHSc‡§; Glick, Lauren BSc*; Fitzcharles, Mary-Ann MD; Adachi, Jonathan D. MD; Cooper, Matthew D. MD#; Gallo, Lucas‡¶; Wong, Laura BHSc‡§; Busse, Jason W. DC, PhD†‡**

JCR: Journal of Clinical Rheumatology: August 2018 - Volume 24 - Issue 5 - p 243–249
doi: 10.1097/RHU.0000000000000679
Original Articles

Background Canadian rheumatologists' attitudes toward and management of fibromyalgia remain uncertain.

Objective The aim of this study was to explore management strategies and attitudes of Canadian rheumatologists toward fibromyalgia and concordance with guideline recommendations.

Methods We administered a 17-item cross-sectional survey to Canadian rheumatologists and explored the concordance between respondents' management practices with the 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia.

Results Among 331 Canadian rheumatologists who were approached, 140 returned the survey for a 42% response rate. The majority felt that fibromyalgia was a useful clinical diagnosis (110/138 [80%]) but was divided as to whether fibromyalgia was objectively defined (75/138 [54%]) or a psychosocial condition (42/138 [30%]) or could result in an inability to work (37/138 [27%]). Contrary to guideline recommendations, most (82/134 [61%]) endorsed that tender points were useful for diagnosis. Half endorsed potentially refusing consultations with fibromyalgia patients, and only 42% (59/139) agreed that there were effective therapies for this syndrome. Consistent with the guideline, most respondents managed fibromyalgia with education, exercise therapy, antidepressants, and nonnarcotic analgesics (≥89% for all); however, fewer than half agreed that any of these modalities were effective (endorsement ranged from 9% to 47%). Assessment of the 2012 guideline revealed a number of important limitations.

Conclusions Canadian rheumatologists largely do not provide primary care for fibromyalgia. Most adhere to guideline recommendations for management of fibromyalgia, but few endorse these interventions as effective. Further research, including updating of the 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia, is required to inform this disconnect.

From the *School of Medicine, University of Toronto, Toronto; and

Department of Health Research Methods, Evidence, and Impact,

Michael G. DeGroote Institute for Pain Research and Care, and

§Faculty of Health Sciences, McMaster University, Hamilton, Ontario;

McGill University Health Centre, Montreal, Quebec;

Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario;

#Department of Rheumatology, University of Calgary, Calgary, Alberta; and

**Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.

No funds were received for the preparation of this manuscript.

The authors declare no conflict of interest.

Correspondence: Jason W. Busse, DC, PhD, Department of Anesthesia, McMaster University, HSC-2U1, 1200 Main St W, Hamilton, Ontario, Canada L8S 4K1. E-mail:

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