A Multidisciplinary Approach to Fibromyalgia

A Conversation with Dr. Susan Chrostowski

Susan K. Chrostowski, DNP, APRN, ANP-C, is an Associate Clinical Professor in the graduate nursing program at Texas Woman’s University (TWU) in Dallas. Dr. Chrostowski conducted a clinical research study on assessment instruments of fibromyalgia disease activity and presented those results at the American College of Rheumatology Annual Scientific Meeting in 2015. She has also presented several national conference presentations on management of fibromyalgia patients.

How long have you worked with fibromyalgia and what led to your interest in it?

When I started working in rheumatology in 2005, I found that patients with fibromyalgia were very challenging to care for because care providers didn’t have a lot to offer in terms of treatment at the time. During my doctoral studies at TWU, I conducted a research study on assessment instruments for fibromyalgia. What providers needed at the point of care was a way to qualify and quantify a patients’ symptoms to determine the best direction to take in managing their care.

Fibromyalgia is a complex condition and our understanding of it is still evolving. What is different now about how providers approach the condition?

I believe there is now a better understanding among providers that fibromyalgia is a real, chronic pain condition. The underlying pathology relates to changes in neuropathways and abnormal pain perception processing. I used to have patients telling me they were told by another provider that fibromyalgia wasn’t “real.” I don’t hear that very often anymore. I think we’ve overcome a lot of that in the medical profession with the research that has been done in recent years.

How does misinformation impact people with fibromyalgia?

It is not only misinformation, but misconceptions that plague the fibromyalgia community. One area of note is the perception that this condition is untreatable and disabling. This mindset victimizes patients and takes away their hope of improving. Other areas of misguidance have come from entities claiming to “cure” fibromyalgia with certain diets or dietary supplements. These false treatments can be very costly for vulnerable patients desperately wanting symptom relief.

It is difficult to understand the symptoms and the pain that these patients are experiencing. This disease is invisible to outsiders. When looking at the person, you are unable to see that anything is wrong. In many cases, it is devastating for patients when their family members don’t understand how they are affected and what limitations it puts on them because physically they look fine.

Is fibromyalgia something that most primary care providers still aren’t looking for but should be? What is important for them to know?

There are an estimated 4 million U.S. adults—about 2% of the population—with fibromyalgia. This is definitely a condition that will be seen fairly often by primary care providers. The patients will need to be evaluated to make sure there isn’t an underlying condition contributing to their symptoms. Then the treatment approach will require multidisciplinary interventions, including pharmacotherapy, physical therapy and cognitive behavioral therapy to achieve the best outcomes.

One challenge facing providers is the limited choice of pharmacological treatments. There are only three medications currently FDA-approved in the U.S. for fibromyalgia. The most recently approved medication was milnacipran in 2009. So, basically, we have not had any new therapies approved in almost 15 years. Even with the approved medications, the studies only showed a modest improvement in symptoms. This is the reason the treatment approach needs to be multifaceted and multidisciplinary.

There are some fibromyalgia treatment centers that do excellent work with multidisciplinary approaches. They use low-impact exercises like swimming and behavioral therapy to teach patients how to cope with and manage their condition. A lot of times we see symptoms improve if we can improve their sleep patterns and reduce stress levels through some of these strategies. Behavioral therapy—that is, working with a psychologist—can help patients learn how to focus on things outside of their pain or fatigue or whatever symptom they’re having. It teaches them tools and coping mechanisms. There are also things like acupuncture or marginal therapies but we don’t have strong data for the benefits of those yet.

What other guidance would you give to primary care providers and specialists interested in treating fibromyalgia?

There is still some stigma about the condition. I have patients that don’t want to accept the diagnosis as a possibility because they don’t want to be stigmatized. I think the biggest thing is to be sympathetic to the patient and to what they’re experiencing; just validate their symptoms. Tell the patients this is a real condition and even though we can’t cure it, we can help them live with it and manage it. Patients need to feel like they are in control and that they have a say over what is being done and how it’s being handled. Talk about areas that they can concentrate on: improving sleep, reducing stress, managing pain. Offer options for addressing those things and allow the patients to guide their own plan of care. That goes a long way in patient adherence and improvement.