key: cord-1005838-xoiu1qt2
authors: Giral, Consuelo Rivera-Miranda; Diaz-Manchay, Rosa; Leon-Jimenez, Franco
title: Fibromyalgia: the underdiagnosed disease of pain
date: 2021-02-28
journal: Reumatologia
DOI: 10.5114/reum.2021.103452
sha: 989e55204efccaac9f66c3fb0c8a1b052a104c88
doc_id: 1005838
cord_uid: xoiu1qt2

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The purpose of this letter is to explain the causes be hind a late diagnosis in fibromyalgia. These are briefly presented below.

Fibromyalgia is a dynamic disease. Patients are clas sified under two phenotypes, one of them being more consistent with clinical criteria than the other. Also, fibromyalgia has two components: a central and peri pheral one; but each can periodically dominate over the other [1] . For an unexperienced physician or one who just considers pain as the cardinal and only symptom, reaching a diagnosis might be difficult and the process slows down [2] . On the other hand, the healthdisease morphophysiological paradigm, in which every patho logy has to possess an evident structural correlation, is another factor that opposes fibromyalgia's variety of clinical manifestations.

Following this line, a 2017 Peruvian study applied to over 100 general practitioners working on primary care in Lambayeque stands out [2] . In this study none of them had acceptable knowledge regarding fibromyalgia, with outstanding ignorance of its diagnostic criteria [2] .

It is important to note how discordance among clini cians has an influence at the moment of studying pain and its characteristics. This symptom might be present in other disorders with which fibromyalgia may coexist, thus leading to a late diagnosis. Moreover, there is re luctance among practitioners to take up these patients given the high psychological burden behind them; phy sicians are also subjected to their own beliefs and preju dices. The rejection negatively impacts the patients, who feel undermined by the people meant to improve their situation, acting as a motivator to keep consulting other healthcare professionals in order to find a solution [1, 3] .

In addition, external consulting has limitations -so little time for so many patients. This drives physicians to shorten the time for anamnesis and physical exami nation, leading to a wrong diagnosis [4] . This implies ineffective treatments along with pain's persistence, un certain prognosis and poor satisfaction regarding medi cal care. The patient's desolation while dealing with crip pling chronic pain affects every dimension of their lives, increased under the stress of being misunderstood by healthcare personnel and their environment.

Finally, it is important to recognize that with such an obstructive pathology as fibromyalgia, an early diag nosis should not be exclusively reserved for rheumato logists. It has to start with primary care in order to pre serve life quality. In our context it has been diminished since hospitals are still focused on COVID19 patients, leaving out every other patient; this represents a risk factor for diagnosis delay. Lockdowns also can trigger a fibro myalgia crisis through depression, anxiety, sleep ing problems, lack of doctor's consultation and even ex acerbations due to COVID19 infection.

The authors declare no conflict of interest.

Are general practitioners well informed about fibromyalgia ?

Conocimientos de fibromialgia en médicos de atención primaria de la provincia de Chiclayo-Perú

Características clínicas y psicosociales de personas con Fibromialgia

Psychological impact of fibromyalgia: current perspectives