Background/Purpose:  Fibromyalgia syndrome (FMS) appears to be undertreated despite the mounting evidence to support the efficacy of interdisciplinary treatment. Why are patients not receiving effective care? Practice needs included a lack of standardized assessment and treatment for patients with Fibromyalgia, inefficient management of patients being referred to Rheumatology for Fibromyalgia creating less availability of Rheumatologists on the consult service as well as reducing availability of appointments for other rheumatologic patients needed for resident teaching as well as low satisfaction for physicians employed in the care of these patients without the support of an interdisciplinary team. The present study was designed to describe the development of a successful interdisciplinary treatment program for Fibromyalgia patients and provide clinical information on the first 600 patients treated in this program between October 2014 and April 2016.

Methods:  The collaborative structure of the interdisciplinary team and the goals of the program are illustrated. Patients referred to a tertiary medical center for evaluation of fibromyalgia symptoms, which were subsequently diagnosed with FMS by meeting the 2010 ACR criteria, enrolled in a 2-day interdisciplinary treatment program, served as subjects in this study. All patients in this study met the ACR Classification Criteria for Fibromyalgia. Patients completed the Fibromyalgia Impact Questionnaire – Revised (FIQR), the Center for Epidemiological Studies Depression Scale (CES-D), and the Pain Catastrophizing Scale (PCS) at the time of admission to the program. Patients were seen in a collaborative care model with trained psychiatric nurses and physicians for diagnosis and then received cognitive behavioral strategies and education in a 2-day course led by health psychologists and nurses.

Results:  Physician feedback revealed that at one year, rheumatology consults had significantly greater availability, a varied patient population was now being seen in the residency program, and physician satisfaction was very high. Of the 600 patients that participated in the Fibromyalgia Treatment Program, the average age of patients was 49 years with a range from 17 to 92. The majority was female (90%). Duration of fibromyalgia symptoms on average was 10 years at the time of referral. Forty-three percent of the patients were regional, 32% national, 24% local and 1% international. The FIQR results revealed severe levels of impairment (62.08); CESD scale scores indicated significant depressive symptoms with an average score of 26; and PCS scores were at elevated levels of pain catastrophizing with an average score of 25. Patient and family satisfaction was uniformly high.

Conclusion:  A successful interdisciplinary program can be developed in a medical practice. The improvement in physician and patient satisfaction in this care model is substantial. Large numbers of patients with Fibromyalgia are still not receiving interdisciplinary care locally producing continued difficulties in functioning and psychological distress.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-development-of-an-interdisciplinary-treatment-program-for-fibromyalgia-in-a-tertiary-medical-center-focused-upon-rheumatology-and-internal-medicine/