“Why am I being referred to a rheumatologist for fibromyalgia?”
My primary doctor diagnosed me with fibromyalgia, but is referring me to a rheumatologist for treatment. Why? I understand that I have pain in my joints, but a rheumatologist doesn't feel right.
5 Answers
Rheumatologists are the most complete medical sub specialist and are usually the doctors who are asked to see the most complex cases in any medical community.
Rheumatologists are asked to confirm a diagnosis of Fibromyalgia and make sure no other process is at play . Patients are referred back to primary care for long term management
Rheumatologists are asked to confirm a diagnosis of Fibromyalgia and make sure no other process is at play . Patients are referred back to primary care for long term management
Hopefully, your doctor took the time to discuss your diagnosis and inform you that this type of specialist usually manages fibromyalgia.
A couple of possible reasons:
1) Your doc is not totally sure of the diagnosis(as fibromyalgia usually involves MUSCLES rather than JOINTS)--and there are some other diseases that can be mistaken for fibro, i.e., Polymyalgia Rheumatica--which usually has a very high ESR (Erythrocyte Sedimentation Rate) or Rheumatoid arthritis, or Lupus, etc.
2) Your doc is sure of the Dx, but is not expert in the TREATMENT of fibromyalgia--as there is no cure, there is no guaranteed treatment, and various treatments may have to be on a "trial and error" basis until a regimen for you seems to work.
But, I agree, usually a good Internal medicine doc can take care of patients with fibromyalgia.
1) Your doc is not totally sure of the diagnosis(as fibromyalgia usually involves MUSCLES rather than JOINTS)--and there are some other diseases that can be mistaken for fibro, i.e., Polymyalgia Rheumatica--which usually has a very high ESR (Erythrocyte Sedimentation Rate) or Rheumatoid arthritis, or Lupus, etc.
2) Your doc is sure of the Dx, but is not expert in the TREATMENT of fibromyalgia--as there is no cure, there is no guaranteed treatment, and various treatments may have to be on a "trial and error" basis until a regimen for you seems to work.
But, I agree, usually a good Internal medicine doc can take care of patients with fibromyalgia.
Your primary care physician may not be entirely comfortable with the diagnosis of fibromyalgia and wants another opinion. There is no test specific for fibromyalgia and the diagnosis is made by exclusion of other diseases, particularly rheumatologic disorders.
J. Tippett, MD
J. Tippett, MD
People often wonder why they are referred to a Rheumatologist when they are diagnosed with Fibromyalgia. This is because chronic widespread pain is the main symptom, and can overlap with many other conditions. These will need to be ruled out:
- Diagnosis includes
- Pain for at least three months
- Pain above and below the waist
- Pain on both sides of the body
This could include combinations of neck pain, shoulder pain, back pain, hip pain, knee pain, feet pain, and pain in just about every part of the body. People with fibromyalgia may also have:
- Hyperalgesia <https://www.fibrocenter.com/fibromyalgia-pain#pain>
(increased
pain in response to normally painful contact)
- Allodynia <https://www.fibrocenter.com/fibromyalgia-pain#pain> (pain
in response to normally nonpainful contact)
None of this pain will show up on an x-ray or blood test. That’s one reason why getting a diagnosis of fibromyalgia from your doctor may take so long. In fact, it takes an average of more than 2 years to get an accurate diagnosis of fibromyalgia.
Fibromyalgia Diagnosis Can Be a Long, Difficult Journey
Even with a doctor who is very experienced with fibromyalgia, diagnosis can take time. This can be frustrating—for the patient and the doctor. Doctors often diagnose fibromyalgia by first ruling out other conditions that have similar symptoms to fibromyalgia.
- Other conditions can occur together with fibromyalgia
- This can confuse diagnosis.
- Typically, a doctor may have to order numerous tests before he or she can rule out other conditions. In fact, the tests that a doctor orders might be quite different on a patient-by-patient basis. Why? While pain is the core symptom of fibromyalgia, patients can experience their fibromyalgia pain differently. Patients also have different ways of presenting their symptoms.
And this last point presents yet another challenge. Doctors sometimes struggle to get the information they need from their undiagnosed fibromyalgia patients. Sometimes, the problem is that patients may have a hard time clearly describing their symptoms. People with fibromyalgia often face a lack of compassion and understanding from others around them. Sufferers may feel isolated and angry. For some, this reluctance to talk about their symptoms can be a serious roadblock to diagnosis.
- Diagnosis includes
- Pain for at least three months
- Pain above and below the waist
- Pain on both sides of the body
This could include combinations of neck pain, shoulder pain, back pain, hip pain, knee pain, feet pain, and pain in just about every part of the body. People with fibromyalgia may also have:
- Hyperalgesia <https://www.fibrocenter.com/fibromyalgia-pain#pain>
(increased
pain in response to normally painful contact)
- Allodynia <https://www.fibrocenter.com/fibromyalgia-pain#pain> (pain
in response to normally nonpainful contact)
None of this pain will show up on an x-ray or blood test. That’s one reason why getting a diagnosis of fibromyalgia from your doctor may take so long. In fact, it takes an average of more than 2 years to get an accurate diagnosis of fibromyalgia.
Fibromyalgia Diagnosis Can Be a Long, Difficult Journey
Even with a doctor who is very experienced with fibromyalgia, diagnosis can take time. This can be frustrating—for the patient and the doctor. Doctors often diagnose fibromyalgia by first ruling out other conditions that have similar symptoms to fibromyalgia.
- Other conditions can occur together with fibromyalgia
- This can confuse diagnosis.
- Typically, a doctor may have to order numerous tests before he or she can rule out other conditions. In fact, the tests that a doctor orders might be quite different on a patient-by-patient basis. Why? While pain is the core symptom of fibromyalgia, patients can experience their fibromyalgia pain differently. Patients also have different ways of presenting their symptoms.
And this last point presents yet another challenge. Doctors sometimes struggle to get the information they need from their undiagnosed fibromyalgia patients. Sometimes, the problem is that patients may have a hard time clearly describing their symptoms. People with fibromyalgia often face a lack of compassion and understanding from others around them. Sufferers may feel isolated and angry. For some, this reluctance to talk about their symptoms can be a serious roadblock to diagnosis.
