title: Fibromyalgia: management strategies for primary care providers.
abstract: OBJECTIVE
  Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management.
  
  
  METHODS
  We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements.
  
  
  RESULTS
  The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes.
  
  
  CONCLUSIONS
  The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training.
  
  
  CONCLUSIONS
  Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting.
authors.affiliation: Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Arnold
authors.affiliation: Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: K B
authors.initials: KB
authors.lastname: Gebke
authors.affiliation: Department of Medicine, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: E H S
authors.initials: EH
authors.lastname: Choy
mesh_terms: D057210:Delayed Diagnosis; D019468:Disease Management; D005221:Fatigue / Q000175:diagnosis; D005356:Fibromyalgia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D010146:Pain / Q000175:diagnosis; D018802:Patient-Centered Care / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*
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