Overcoming Obstacles: Barriers to Care in Fibromyalgia Treatment*

Many patients with fibromyalgia syndrome (FMS) receive inadequate or ineffective treatment, often because of multifactorial barriers that stand in the way of appropriate care. These barriers include the high prevalence of medical and psychiatric comorbidities in patients with FMS, the challenges inherent in diagnosing FMS, and the perception among many that FMS is not a “real” disease. Another major obstacle is that there is often little or no coverage for patients with FMS who do have health insurance, and restricted access to healthcare for those who do not. This article reviews these and other patient-, physician-, and process-related barriers and explains how they interfere with treatment. The article also suggests several common-sense strategies aimed at overcoming these obstacles and improving care for patients with FMS. (Adv Stud Med. 2009;9(4):115-121) M any patients with fibromyalgia syndrome (FMS) receive inadequate or ineffective treatment. In part, this is a direct reflection of the lack of consensus among clinicians with respect to diagnosis, causes, and effective treatments. In large measure, however, inappropriate care can be attributed to numerous multifactorial barriers that need to be overcome. These barriers fall into 4 broad but interrelated categories: patient-related factors; physician-related factors; work and social impairment; and factors involving “process,” such as delayed diagnosis and inadequate healthcare coverage. The categories overlap to some extent, just as FMS frequently overlaps with several other pain syndromes and psychiatric conditions. Factors in each of the categories are reviewed in detail in this article, as well as strategies to overcome these obstacles.