Background/Purpose: It is anticipated that patients with high expectations for improvement of their medical condition may get frustrated when a significant degree of benefit does not occur with treatment. Medication and the non-medication therapy of fibromyalgia can be challenging. We asked fibromyalgia patients what their expectations were regarding past and current treatment. 

Methods: Office patients were asked to complete a questionnaire about their expectations of treatment with respect to its general effect and its effect on pain, sleep quality, quality of life, and energy. Each item was rated 1-3 with 3 indicating the highest expectations. A total expectation score consisting of the mean of these expectation items was calculated. Patients also rated from 1-3 how challenging their rheumatic disease was with 3 as the most challenging rating. Three diagnosis groups were compared with respect to questionnaire responses: 91 FMS patients, 34 RA patients, and 14 SLE patients. The Kruskal-Wallis and Mann-Whitney tests were used to compare groups with respect to the items and total scores, and the Spearman correlation was used to test for linear association between the disease challenge rating and the total expectation score for each group, with a two-sided 0.05 significance level.

Results:

Compared to RA patients, FMS patients considered their disease significantly more challenging (FMS 2.2 ± 0.7, RA 1.6 ± 0.8, p < 0.001) and had significantly higher general treatment expectations (FMS 1.8 ± 0.5, RA 1.2 ± 0.4, p < 0.001), significantly higher treatment expectations concerning pain (FMS 1.8 ± 0.6, RA 1.4 ± 0.5, p = 0.010), and significantly higher total treatment expectation scores (FMS 1.9 ± 0.4, RA 1.6 ± 0.4, p = 0.009). Compared to RA patients, SLE patients also had significantly higher general treatment expectations (SLE 2.0 ± 0.6, RA 1.2 ± 0.4, p < 0.001), significantly higher treatment expectations concerning pain (SLE 2.0 ± 0.7, RA 1.4 ± 0.5, p = 0.011), and significantly higher total treatment expectation scores (SLE 2.0 ± 0.6, RA 1.6 ± 0.4, p = 0.037). There were no statistically significant differences between FMS and SLE patients. For each group, a statistically significant positive Spearman correlation was found between the disease challenge rating and the total expectation score, so that higher expectation scores were associated with higher disease challenge ratings: FMS rho = 0.37 (p = 0.001), RA rho = 0.50 (p = 0.005), SLE rho = 0.58 (p = 0.0498).

Conclusion: Patients with fibromyalgia who have higher expectations for significant improvement may find be impossible to meet those expectations in many cases.  A meaningful therapeutic relationship can help some patients cope with their illness better, but many fibromyalgia patients are currently frustrated by a lack of significant benefit from current therapy, especially those patients who have high expectations for improvement. Cognitive behavior therapy might help some patients with unrealistic expectations cope with their illness better.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fms-and-sle-patients-have-higher-treatment-expectations-than-ra-patients/