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All About FibromyalgiaA Guide for Patients and their Families$
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Daniel J. Wallace and Janice Brock Wallace

Print publication date: 2002

Print ISBN-13: 9780195147537

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780195147537.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 13 June 2021

What Happens at a Fibromyalgia Consultation?

What Happens at a Fibromyalgia Consultation?

15 What Happens at a Fibromyalgia Consultation?
All About Fibromyalgia

Daniel J. Wallace

Janice Brock Wallace

Oxford University Press

Fibromyalgia is usually a diagnosis of exclusion. Often poorly understood by some primary care physicians, the diagnosis of fibromyalgia is often delayed. Even though in one survey up to 10 percent of general medical visits involve a complaint of generalized musculoskeletal pain, the diagnosis was made only after patients saw a mean of 3.5 doctors. This chapter will take you through the workup that establishes the definitive diagnosis and eliminates other possible explanations for the patient’s complaints. Doctors who diagnose and treat fibromyalgia often cross specialty lines. Although rheumatologists tend to regard fibromyalgia as residing within their bailiwick, there are too few of us to handle all the needs of the 6 million fibromyalgia sufferers. The 5,000 rheumatologists in the United States are internal medicine subspecialists. A total of 80,000 doctors practice primary care internal medicine in the United States, and an additional 80,000 general or family practitioners are the front-line doctors for most patients. These physicians may suspect fibromyalgia and consult a rheumatologist to confirm the diagnosis. In complicated cases, the rheumatologist can take over the management of the condition. Orthopedists, neurosurgeons, and neurologists frequently diagnose fibromyalgia but generally refer patients to rheumatologists or internists for treatment. Rheumatologists may refer patients to physical medicine specialists or pain management centers when their approaches do not bear fruit. Suppose that you are suspected of having fibromyalgia, and a primary care physician has referred you to a fibromyalgia consultant (usually a rheumatologist but sometimes an internist, physiatrist, neurologist, orthopedist, or osteopath) to confirm the diagnosis and make management suggestions. Is any sort of advanced preparation advisable? Yes. Bring copies of outside records and previous test results or workups to the consultant. If you have more than a few complaints or are taking more than a few medications, a summary list is useful. The evaluation will consist of a history, physical examination, diagnostic laboratory tests, and possibly imaging studies (X-rays, scans, etc.). Once all the observations and test results are in, the doctor will discuss the findings with you—perhaps at the time of the visit, by telephone after the initial meeting, or in a follow-up visit.

Keywords:   burning, constitutional symptoms, diagnosis, electrical evaluations, gastrointestinal system, hematologic factors, imaging studies, myelogram, neuropsychiatric history, physical examination

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