Moving Forward: Fibromyalgia Patients in Primary Care

Fibromyalgia is a complex chronic pain syndrome that affects up to five percent of the American population. Common symptoms include muscle and joint pain, stiffness, fatigue, headaches, and irregular sleep patterns. The syndrome primarily occurs in young and middle-aged women, but men and children develop the illness as well. Diagnosis is also high among people with existing chronic illnesses. Although the majority of Fibromyalgia patients in Primary Care are women, they come from all backgrounds and span all ages.

Unfortunately, the cause of Fibromyalgia is unknown. This ambiguity presents a challenge to traditional primary care settings.⁽¹⁾ Therefore, it is extremely important that patients stay educated and maintain good communication with their physicians and other healthcare professionals. One effective tool for both patients and practitioners is Medicare’s Chronic Care Management  program(CPT 99490). Through proven patient engagement methods and information management, a CCM coordinator provides the guidance and synchronization to ensure effective treatment for Fibromyalgia patients.

Finding a Home: Fibromyalgia Patients in Primary Care Settings

Fibromyalgia is a functional pain syndrome. In other words, the body amplifies ordinary sensations as pain. Since there is no known organic cause, researchers are unsure if Fibromyalgia is a singular disorder, or if it is a collection of similar diseases categorized under one umbrella.⁽²⁾ As such, there is no real consensus in the medical community regarding diagnosis or treatment. Despite breakthroughs in identifying biomarkers and documenting impacts of the disease on the nervous system, there is no verified diagnostic test or medical intervention.^{(3) (4)} Because of this, a diagnosis of Fibromyalgia comes with an unclear treatment path.

Without an understanding of the underlying cause of Fibromyalgia, without a definitive diagnostic guideline, and without replicated testing of the physiological impact it has on the body, the medical community struggles to find Fibromyalgia patients a home.⁽⁵⁾ Instead, patients are sent to a variety of specialists to rule out other diseases and disorders that have more conclusive tests. This means that patients frequently see rheumatologists, neurologists, psychiatrists, psychologists, general internists, osteopathic physicians, chronic pain clinics, as well as multiple visits with their PCP. Coupled with the lingering social stigma of the syndrome, many patients defer treatment efforts and they lack the support needed to cope with a chronic condition.⁽⁵⁾⁽⁶⁾ All of this make Fibromyalgia patients in Primary Care Practices a challenge.

Pain and Fatigue: A Reinforcing Circle

The most common symptom of Fibromyalgia is pain. This pain can be dull and achy, or acute and sudden. The pain can occur in any part of the body and often begins without an outside cause. While many people experience muscle pain, others experience joint pain, and some experience both. Levels of pain and areas that are affected can change throughout a person’s life.⁽⁷⁾ Most patients experience flares, or times when symptoms increase. Some patients experience periods of “remission,” or times when the symptoms are barely noticeable, but these intervals are rare. Therefore, pain management is essential to any Fibromyalgia patient.

The second most common symptom is severe fatigue. This symptom can vary in intensity and duration, just like pain. Currently, it is unknown if fatigue is directly caused by the syndrome, or if it is caused by pain induced sleep deprivation.⁽⁸⁾ No matter what the source, the consequences are clear. Over three-quarters of patients report memory lapses, difficulty staying awake, interference in activities of daily living, absences from work, and disruption of social life.⁽⁵⁾⁽⁸⁾ In spite of its prevalence, fatigue is often overlooked during diagnosis and treatment. Usually, Fibromyalgia patients find relief with good management of other symptoms.

Fibromyalgia Patients: Providing Resources

Treatment plans, therefore, need to provide both immediate relief and long-term planning. A many-pronged approach is the most effective way to treat Fibromyalgia patients in Primary Care. A strong foundation begins with patient education. Afterwards, physicians can start the process of finding the right combination of self-management and medical intervention that will work for their patient. This is a time consuming process and not all practices are equipped to invest these resources.

This is where CCM comes into play. Through partnership with CareHarmony, a leading CCM coordination provider, physicians can be confident that their patients are receiving the education and guidance they need. Care coordinators, in conjunction with physicians, create care plans for each patient. They track medication compliance, symptoms, and exercise regimens. In addition, care coordinators help participants keep track of their multiple doctors’ appointments and referrals. This added service enhances treatment effectiveness, which is a difficult process for both patients and physicians. In short, Fibromyalgia patients in Primary Care settings greatly benefit from the assistance that care coordination offers. Providing this service, through CareHarmony, adds substantial value to Fibromyalgia patient care.

References

1. Arnold, L. M., Gebke, K. B. and Choy, E. H. S., “Fibromyalgia: Management Strategies for Primary Care Providers,” International Journal of Clinical Practice, 70 (2016): 99–112. [Online: June 14, 2017] http://onlinelibrary.wiley.com/doi/10.1111/ijcp.12757/full
2. Crabtree, David and Praveen Ganty, “Common Functional Pain Syndromes,” Medscape, 2016; 16(10): 334-340. [Online: June 21, 2017] http://www.medscape.com/viewarticle/870947
3. Mayo Clinic Staff, “Fibromyalgia: Symptoms and Causes,” 2017, May 2 [Online: June 15, 2017]. http://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/dxc-20317796
4. National Institute of Arthritis and Musculoskeletal and Skin Disease, “Questions and Answers about Fibromyalgia,” Fibromyalgia, 2014, July, [Online: June 15, 2017]. https://www.niams.nih.gov/health_info/fibromyalgia/
5. Johns Hopkins Medicine, National Fibromyalgia Association, and Pharma Com Group, Inc. Fibromyalgia in Primary Care: Incorporating Patient Insights into Patient Care, A Series of Live CME Teleconferences/Webinars, an Enduring Web Archive and Online Slides with Transcript, 2016. [Online: June 21, 2017]. http://www.fmaware.org/wp-content/uploads/2015/06/CME-Needs-Assessment.pdf
6. Kuzma, Cindy, “Coping with the Social Stigma of Fibromyalgia,” Health Grades, 2017, February 7; William C. Lloyd III, MD, FACS, Medical Reviewer. [Online: June 15, 2017]. https://www.healthgrades.com/conditions/coping-with-the-social-stigma-of-fibromyalgia
7. Nichols, Hannah, “Fibromyalgia Flares: Warning Signs and Treatments,” Medical News Today, 2017, February 6. [Online: June 21, 2017] http://www.medicalnewstoday.com/articles/315646.php
8. Vincent, Ann et al, “Beyond Pain in Fibromyalgia: Insights into the Symptom of Fatigue,” Arthritis Research and Therapy, 2013; 15(6): 221. [Online: June 21, 2017]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978642/