Background/Purpose: Fibromyalgia (FM) is a chronic, widespread pain disorder driven by dysregulated central pain processing, which impairs daily function and quality of life. Current understanding of clinicians’ knowledge, practices, and perceptions towards FM in the real world is critical to identifying gaps in FM management and informing future treatment strategies. A national chart review was conducted among US-based healthcare providers (HCPs) caring for patients with FM to characterize their views and understanding of FM, diagnostic and treatment practices, and satisfaction with current therapies.

Methods: An online chart review was conducted from December 2023 to January 2024 among 199 US HCPs with FM expertise, including primary care physicians (PCPs), rheumatologists, pain specialists, and aligned nurse practitioners and physician assistants. Eligible HCPs had been practicing ≥2 years, treated ≥20 adult patients with FM over the past 3 months, and were aware of duloxetine, milnacipran, or pregabalin. Each HCP contributed data from 2 patient charts.

Results: A total of 398 patient charts were reviewed by 199 HCPs, including 99 rheumatologists, 50 pain specialists, and 50 PCPs. Respondents were highly experienced, managing an average of 91 patients with FM each over the past 3 months. Among all respondents, 70% of treating rheumatologists had also diagnosed the patients themselves (vs 58% of PCPs and 38% of pain specialists). Across specialties, multiple diagnostic tools were used: tender point exams (79%), diagnosis by exclusion (69%), and American College of Rheumatology or ACTTION-APS Pain Taxonomy criteria (68%).The average age of patients with audited charts was 48 years, with most respondents agreeing that the age of their newly diagnosed patients had decreased in recent years. Across specialties, pain (81%), followed by fatigue (57%) and muscle tenderness (51%) were key drivers of treatment decisions. There was no clearly defined standard of care among pharmacotherapies. Across all respondents’ treated patients, duloxetine, gabapentin, and pregabalin were evenly used across lines of therapy; use of opioids (including tramadol) was more common in the third line and beyond (33% of ≥third line patients). Most respondents (88%) were comfortable prescribing multiple pharmacotherapies for FM, despite 76% expressing concern about drug-drug interactions. Respondents reported that 39-51% of patients were dissatisfied or coping but interested in switching treatments. Most (59%) viewed FM patients as time-consuming to manage, and 32% believed most of their patients were unlikely to improve despite treatment. A large majority (85%) believed FM is stigmatized by the HCP community.

Conclusion: This recent patient chart review among US-based HCPs who are highly experienced in managing patients with FM shows continuing variability in diagnostic and treatment practices, limited satisfaction with current therapies, and concern that patients are unlikely to improve despite treatment even though progress has been made in disease area knowledge and earlier identification. Greater knowledge of FM, its diagnosis and management, and new treatment options will help further support patient care and improve outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/physician-practices-and-perspectives-in-the-diagnosis-and-management-of-fibromyalgia-a-us-chart-review-study/