The Psychiatrist confronted with a Fibromyalgia Syndrome patient

A psychiatrist at the Medical University of Vienna, Austria has written an article concluding that psychiatrists are well placed to initiate treatment for Fibromyalgia Syndrome patients they encounter, as the treatment of Fibromyalgia Syndrome involves a multidisciplinary approach and the use of medications that are typically well known to psychiatrists.¹

The author notes that Fibromyalgia Syndrome (Fibro) is usually treated by rheumatologists but since co-morbid depression and anxiety are frequently found, psychiatrists are likely to be confronted with patients suffering from the syndrome.

The symptoms associated with Fibro vary from patient to patient but there is one common symptom - they ache all over. In addition to pain, patients report headaches, poor sleep, fatigue, depressed mood and irregular bowel habits, which are also all also symptoms of depression. For a formal diagnosis of Fibro, the American College of Rheumatology (ACR) criteria require the patient to have widespread pain for at least 3 months together with tenderness at 11 or more of 18 specific tender points.

The article notes that treatment of Fibro requires a comprehensive approach involving education, aerobic exercise and cognitive behavioural therapy in addition to pharmacotherapy. Psychiatrists are accustomed to initiating this kind of treatment for their patients who only have mental health issues.

Some of the most effective drugs available for the treatment for Fibro, such as the serotonin noradrenaline reuptake inhibitors (SNRIs), milnacipran and duloxetine, and the anti-epileptic, pregabalin, are well known to psychiatrists.

The article therefore concludes:

"Thus the psychiatrist is well placed to initiate treatment in these patients."

It could be noted here that neurologists would be even better placed to initiate treatment of Fibro. However, not many neurologist realise how much they would already know about the processes and treatments involved with Fibro.

References:

1. Kasper S. The psychiatrist confronted with a fibromyalgia patient. Hum Psychopharmacol. 2009 Jun;24 Suppl 1:S25-30.