Conceptuación de la fibromialgia en profesionales de la salud y pacientes

Abstract

The symptoms of fibromyalgia have been conceptualized and classified in different ways throughout history, either as a form of neurosis or as a musculoskeletal or immunoneuroendocrine entity. The latter is currently the most accepted by the leading management guidelines for fibromyalgia and international associations. However, the so common emotional characteristics and psychosocial factors among this population have questioned the successive biomedical approaches. All this has resulted in a poor nosological and conceptual delimitation, with a diagnosis misuse and problems in its clinical management. The proliferation of fibromyalgia patients and the usual emotional characteristics arouse suspicion of the nature of the entity. Likewise, patients often perceive rejection by physicians, as well as are confused and frustrated for suffering from a disease with an unknown cause. Objectives The general aim of this dissertation was to explore the conceptualization of fibromyalgia by healthcare providers and patients. The specific objective was to analyze the possible differences in the perspective among patients and physicians from different countries and continents. Methods Three descriptive, ex post facto, cross-sectional studies were carried out through ad hoc questionnaires. The first study included 103 healthcare providers from different clinical management units —primary care, rheumatology, internal medicine, and mental health specialties— of centers and hospitals from the province of Almería (Spain). The second study included 603 patients with fibromyalgia assigned to different patient associations from Spain and Latin American countries. The third study included 284 physicians from five continents. A convenience sampling was followed in study 1 and 2. In study 3, a snowball sampling was followed. Results In the first study, 59.7% of primary care physicians and 66.7% of internist showed a perception of FM based on somatization, compared to the absence of rheumatologists who indicated it. A total of 58.9% of primary care providers mentioned that fibromyalgia should be considered as a disabling disease in no case, although 57.5% considered necessary its diagnosis. Likewise, more than 70% of primary care, mental health, and internal medicine providers did not differentiate fibromyalgia well from other entities, the most frequent being mood disorders. The combination of most mentioned treatments (with 27.2%) was one that combined pharmacological, physical, psychological, and educational treatment. In the second study, the patients attributed to their fibromyalgia the symptoms of sore throat, eye irritation, and/or whistles, resulting in a higher proportion of participants from Spain who attributed these symptoms. From 45% of the Spanish participants, there was no type of pharmacological treatment that could improve their symptoms in comparison with 33.3% of patients from Latin American countries. Furthermore, a greater proportion of patients from Latin America found food supplements (21.9%) and some pseudotherapies (18.1%) to some extent effective solutions, compared to Spanish patients (6% and 5%, respectively). The most attributed causes were stress, inheritance, psychological traumas, and emotional problems. The results of the third study indicated the existence of beliefs about false signs and symptoms, such as trigger points. These beliefs were found in 18.5% of all participants, and to a greater extent on those more industrialized continents. Other false symptoms cited were musculoskeletal (5.3%), inflammatory, or vascular problems. Psychological or behavioral problems were mentioned as the cause of fibromyalgia by 32.2% of the participants. Likewise, 17.4% reported alterations in the central nervous system as the cause of fibromyalgia, being less mentioned by participants from Africa and Asia (0% and 8.6%, respectively). The most recommended treatment by participants was the pharmacological one (73.5%). Conclusions Healthcare providers and patients attribute psychological causes to fibromyalgia, with a disagreement between the clinical context and the scientific context. Although providers have good knowledge about the disease, they are more profound among specialties such as rheumatology, and among those more industrialized continents. Also, false symptoms are attribute to fibromyalgia, although it is more prominent among patients. Regarding clinical management, professionals believe in a multicomponent treatment, highlighting the pharmacological one.