GPs can treat Fibro just as well as consultants

Fibromyalgia Syndrome (Fibro) can be treated within the primary care setting, and getting treatment quickly leads to better outcomes, according to an article recently e-published ahead of print in the journal Arthritis Research & Therapy. [1]

The study aimed to compare the efficacy of the treatments for Fibro available in both primary care and specialised settings, as well as to look at variables that improve the outcome of treatment. [1] Primary care would normally be medical care with a GP, and specialised care would be with a specialist clinic or a hospital consultant.

The researchers looked at reports of randomized controlled trials researching pharmacological and non-pharmacological treatments for Fibro, available in the research resources MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and PsychInfo, with the most recent electronic search being carried out in June 2006. Of the 594 articles identified by abstract and title, 102 full articles were retrieved and 33 of these met the inclusion criteria. These randomised controlled trials assessed 120 treatment interventions on 7789 patients diagnosed with primary Fibromyalgia Syndrome, of which 4505 (57.8%) were included in the primary care group and 3284 (42.2%) in the specialised intervention group. The patients were mostly middle-aged women who had been suffering from Fibro for 6-10 years. [1]

The researchers found that the treatments used in the studies were on average effective, but that there was no significant difference in treatment efficiacy between the patients treated in a primary care setting and those treated in a specialised care setting. They concluded that there was no particular need for specialised care in treating Fibro. [1] The main factor affecting how efficient treatment for Fibro from different doctors is, is often how much knowledge of the condition they have. As Fibro does not fall properly into any one medical discipline, little training is given about the condition, even at consultant level. Primary care practitioners or General Practitioners (GPs) can therefore have as much information and knowledge as their more specialised colleagues.

The researchers also found that variables (that were not affected by the differences in the trials) that improved the outcome of patients receiving treatment were younger age of the patients and shorter duration of the disorder. In other words, the patients who were more likely to do well were young and hadn't been suffering from Fibro for very long. [1]

There were a number of issues with the trials used in this study, such as the varying quality of the trials and the different length of time the treatments were trialled impacting on the results. [1] The number of trials that fit the inclusion criteria was also relatively small.

Past studies have had mixed results as to whether duration of illness is a factor in how well Fibro patients respond to treatment. [2] However, anecdotal evidence suggests that on average, Fibro patients worsen over time, especially during the first few years of the condition. Timely treatment may mean that the condition is less severe, so that less improvement is needed to return the patient to a reasonable level of functionality and symptom relief. It may also make it less likely that reactive depression because of the Fibro develops [3] and psychiatric comorbidities negatively impact the severity and course of Fibro [4] so preventing these developing could lead to a better outcome for patients.

References:

1. Garcia-Campayo J, Magdalena J, Magallon R, Fernandez-Garcia E, Salas M, Andres E. Efficacy of fibromyalgia treatment according to level of care: a meta-analysis. Arthritis Res Ther. 2008 Jul 15;10(4):R81. [Epub ahead of print]
2. Wigers SH. Fibromyalgia outcome: the predictive values of symptom duration, physical activity, disability pension, and critical life events--a 4.5 year prospective study. J Psychosom Res. 1996 Sep;41(3):235-43.
3. Bigatti SM, Hernandez AM, Cronan TA, Rand KL. Sleep disturbances in fibromyalgia syndrome: Relationship to pain and depression. Arthritis Rheum. 2008 Jun 24;59(7):961-967. [Epub ahead of print]
4. Arnold LM. Management of fibromyalgia and comorbid psychiatric disorders. J Clin Psychiatry. 2008;69 Suppl 2:14-9.