Abstract
Background/Aims
To examine the management of fibromyalgia patients referred to secondary care with respect to 2017 European Alliance of Associations for Rheumatology (EULAR) guidelines.
Methods
Eighty-two patients referred to the Complex Musculoskeletal Clinic in the Rheumatology Department with a resulting diagnosis of fibromyalgia were included in the audit. Data was collected retrospectively via Electronic Patient Records over the study period of December 2017 to March 2020. Variables assessed included patient demographics, clinical presentation at assessment and management. Statistical analyses were conducted using Excel 2019 and the Excel Analysis ToolPak.
Results
The majority of the patients were female 77/82(94%), and the mean age was 43.2yrs (SD = 12.6). Co-morbidities were common: 31/82 (38%) had a further painful musculoskeletal condition, 40/82 (49%) were obese and 46/82 (56%) had an active mental health problem. Alongside chronic widespread pain, patients reported fatigue 64/82 (78%), waking unrefreshed 69/82 (84%), and cognitive disturbance 31/82 (38%). Compared to a 2014 audit conducted in the same population and department, more patients had received pharmacological treatment (71/82 [87%] vs 34/50 [68%]; z = 2.64, p = 0.008), had received physiotherapy (28/82 [34%] vs 5/50 [10%]; z = 3.0, p = 0.002) and psychological input (16/82 [20%] vs 3/50 [6%]; z = 2.20, p = 0.03) prior to referral to secondary care. At secondary care consultation, all patients received an assessment of their pain and function, and 64/82 (78%) were assessed for psychosocial context. Fifty-three (65%) patients received information in the form of a website recommendation, leaflet or verbal education. After clinician assessment, the majority were referred to a multidisciplinary pain management programme, in a significant increase from 2014 (64/82 [78%] vs 4/50 [8%]; z = 8.04, p < 0.0001). All medication recommendations were made according to 2017 EULAR guidelines. Alongside multidisciplinary pain rehabilitation, patients were referred to physiotherapy 21/82 (26%), physical activity 26/82 (26%), sleep hygiene 9/82 (11%) and psychological 7/82 (9%) treatment options.
Conclusion
Multidisciplinary treatment and first-line, non-pharmacological approaches have become the standard management approach in secondary care, alongside EULAR compliant pharmacological recommendations. EULAR’s non-pharmacological recommendations of assessing not only pain, but function and psychosocial context occurs for the majority of patients. The limitation of consultation duration likely plays a role in whether psychosocial context is adequately assessed. Providing patients with information about their condition, though occurring for approximately 2/3 of patients, was recognized as an area for improvement. The high rate of co-morbidities combined with the demographics of Fibromyalgia patients emphasizes the importance of early, multimodal management. Follow-up audits are warranted to examine the effects of the COVID-19 pandemic, and the impact of the upcoming 2021 NICE guidance for chronic pain.
Disclosure
Y. Kang: None. R. Smith: None. A. Soni: Grants/research support; Oxford-UCB Prize Fellowship.
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