Knowledge on cause, clinical manifestation and treatment for fibromyalgia among medical doctors: A worldwide survey.

OBJECTIVES: Hench introduced the fibromyalgia syndrome almost 50 years ago. In the meantime, the prevalence has increased, the clinical criteria have changed and the way we explain (chronic) pain has altered. DESIGN: In the current study, we conducted a worldwide survey in which we investigate whether medical doctors are familiar with the American College of Rheumatology (ACR) criteria for fibromyalgia and, if so, whether these medical doctors adhere to the clinical guidelines following evidence-based treatments. RESULTS: In total, 286 medical doctors from 43 countries spread over 6 continents filled out the survey. In most of the countries, the diagnosis fibromyalgia was used. Only 10% adhere to the ACR criteria, widespread pain (44%), unrefreshed sleep (24%), fatigue (20%) and cognitive problems (8%) were most used diagnostic criteria. Of the respondents, 94 (32%) mentioned that the cause is unknown or idiopathic, but also a wide variety of other causes was mentioned. More than 70 different treatment options were provided, of which 24% of the responses were classified as according to the clinical guidelines. From this study, we conclude that many medical doctors do not follow the ACR criteria; the majority has an inappropriate knowledge of causes for fibromyalgia and that a minority of treatment advice adhere to the guidelines.

Reappraising personal values in cancer: Meaning-in-life adaptation, meaningfulness, and quality of life.

OBJECTIVE: This study explores the reappraisal of personal values among people with cancer post-diagnosis and its connections to meaningfulness, encompassing personal meaning and sense of meaning, and various dimensions of quality of life. METHODS: A total of 144 patients with diverse cancer types and a control group comprising 158 healthy adults with similar demographic characteristics completed the Valued Living Questionnaire-Perceived Change, the Personal Meaning Profile-Brief, the Portrait Values Questionnaire, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being. RESULTS: Cancer patients displayed a substantial values reappraisal compared to healthy adults. They reported an increased significance of social areas and self-transcendental values, including close relationships (family, partner, and friends), spirituality, citizenship, and universalism, as well as an increased importance of self-care and self in general. Conversely, cancer patients assigned less importance to work and self-enhancement values such as stimulation, power, and achievement. Cluster analysis revealed that patients who reappraised their values exhibited higher meaningfulness and better indicators of quality of life, including spiritual and physical well-being, compared to patients who did not modify their value system. CONCLUSIONS: These findings underscore the importance of assessing and promoting meaning-in-life adaptability among people with cancer, with potential applications in meaning-centered therapies and interventions aimed at enhancing psychological flexibility.

[Conceptuation on fibromyalgia: consensus or discrepancy among healthcare providers from Spain?] / Conceptuación de la fibromialgia: ¿consenso o discrepancia entre profesionales clínicos de España?

OBJECTIVE: The clinical approach of fibromyalgia is a cause of frustration for some professionals due to the controversy on its diagnosis, etiopathology and clinical management. The aim of this study was to explore the beliefs and knowledge on fibromyalgia among health professionals from different specialties of the public health service from Almería province. METHODS: A descriptive and cross-sectional study was carried out. A questionnaire prepared ex profeso was applied to a sample of 103 clinicians from Primary Care Physicians, Mental Health, Internal Medicine and Rheumatology. The chi-square test was performed to explore the relationships among variables. RESULTS: 59.7% of Primary Care providers and 66.7% of Internal Medicine conceptualized fibromyalgia as a somatization. Likewise, 58.9% of Primary Care indicated that fibromyalgia should be considered in no case as a disabling illness, compared to 16.7% from Rheumatology, as well as for 42.5% of them the fibromyalgia diagnosis is not essential, compared to the amount of other specialties. Mood disorders were mentioned by 53.4% of Primary Care as entities from which fibromyalgia is difficult to discriminate. Sleep or gastrointestinal problems were mentioned by 83.3% and 50% of Rheumatology professionals, respectively. CONCLUSIONS: A high percentage of professionals considered fibromyalgia as a psychogenic entity, especially among Internal Medicine and Primary Care, highlighting in the last one a position against the consideration of disability and its difficult differentiation from mood disorders. These latest findings could be explained by beliefs or attitudes on the amplification of pain behaviors and secondary gains. A deeper knowledge on fibromyalgia symptoms from Rheumatology is highlighted. Methodological limitations and recommendations are discussed.

OBJETIVO: El abordaje clínico de la fibromialgia es causa de frustración para algunos profesionales por la controversia en su diagnóstico, etiopatología y manejo clínico. El objetivo del presente estudio fue explorar cuáles son las creencias y conocimientos hacia la fibromialgia por parte de profesionales de distintas especialidades del ámbito público de salud de la provincia de Almería. METODOS: Se trató de un estudio descriptivo y transversal. Se aplicó un cuestionario elaborado ex profeso a una muestra de 103 clínicos de Atención Primaria, Salud Mental, Medicina Interna y Reumatología. Se exploró la relación de las variables mediante la prueba chi-cuadrado. RESULTADOS: El 59,7% de los profesionales de Atención Primaria y el 66,7% de los de Medicina Interna conceptuaron la fibromialgia como una somatización. Asimismo, el 58,9% de los profesionales de Atención Primaria indicó que en ningún caso había de considerarse como una enfermedad discapacitante, en comparación con el 16,7% de los de Reumatología, así como que para el 42,5% no era fundamental su diagnóstico, en comparación a la totalidad en otras especialidades. Los trastornos del ánimo, como entidades de las que resulta difícil de discriminar la fibromialgia, fueron mencionados por el 53,4% de los de Atención Primaria. Los problemas de sueño o problemas gastrointestinales se mencionaron en mayor medida como manifestaciones clínicas entre los de Reumatología (83,3% y 50%, respectivamente). CONCLUSIONES: Un alto porcentaje de profesionales conceptúan la fibromialgia como una entidad psicógena, en especial, profesionales de Medicina Interna y Atención Primaria, destacando en esta última una posición en contra de la consideración de discapacidad y su difícil diferenciación de los trastornos del ánimo. Estos últimos hallazgos podrían explicarse por creencias o actitudes respecto a la amplificación de las conductas del dolor y la obtención de ganancias secundarias. Destacan los conocimientos más profundos de la sintomatología en Reumatología. Se discuten las limitaciones metodológicas y recomendaciones.