title: A patient and physician survey of fibromyalgia across Latin America and Europe.
abstract: BACKGROUND
  Patients and physicians from three Latin American (LA) and six European countries were surveyed in order to describe differences in journey to diagnosis, impact, and management of fibromyalgia (FM).
  
  
  METHODS
  900 patients (300 LA; 600 Europe) and 1824 physicians (604 LA; 1220 Europe) were surveyed between October-December 2010 (LA) and February-April 2008 (Europe). Patients and physicians (GP or specialists) completed separate questionnaires, on symptoms, impact, and FM management. Interviews were conducted in local languages. Appropriate rating scales were used throughout. Data were analyzed using cross-tabulations and descriptive statistics. Significance was determined at P<0.05 (indicated by *).
  
  
  RESULTS
  In LA versus Europe, patients reported having FM symptoms for longer (100.8 vs. 83.7* months), and taking longer to be diagnosed (42.3 vs. 31.1* months). FM was characterized by multiple symptoms (11.2 vs. 6.9), but more LA patients reported 14 common symptoms*, and rated pain higher on 11-point scale (8.0 vs. 7.2*). LA patients were taking fewer medications (3.3 vs. 4.0). Patients from both regions found common symptoms very/extremely disruptive to their quality of life, but symptoms impacted daily living and ability to work more significantly in LA. Physicians (GPs or specialists) from LA more often considered problems sleeping*, difficulty concentrating*, anxiety*, depression*, numbness/tingling*, and leg cramps* very/extremely disruptive vs. European physicians. Despite headache, heightened sensitivity to touch, difficulty concentrating, and joint pain being experienced by ≥50% of patients from both regions, <15% of PCPs or specialists considered these typical FM symptoms. Patients also considered 12/14 symptoms more disruptive than PCPs or specialists in the same region. However, a higher proportion of PCPs or specialists considered FM to have a strong/very strong impact on aspects of daily living vs. patients within the same region.
  
  
  CONCLUSIONS
  Patient- and physician-rated disease perception and impact was often higher in LA than in Europe. Patient and physician perspective concerning FM impact and disruption were often misaligned within the same region. Our observations may be representative of cultural differences in stoicism, expression, beliefs, and attitudes to pain perception and management. Better understanding of these complexities could help targeted educational/training programs incorporating cultural differences, to improve chronic care.
authors.affiliation: Clinical Epidemiology Unit HIM-Federico Gómez Faculty of Medicine UNAM, Colonia Doctores, DF, Mexico City, Mexico.
authors.forename: Patricia
authors.initials: P
authors.lastname: Clark
authors.forename: Eduardo S
authors.initials: ES
authors.lastname: Paiva
authors.forename: Anna
authors.initials: A
authors.lastname: Ginovker
authors.forename: Patricia Arline
authors.initials: PA
authors.lastname: Salomón
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019468:Disease Management; D005060:Europe; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006306:Health Surveys; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D010146:Pain; D010147:Pain Measurement; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011788:Quality of Life; D055815:Young Adult