A Sociological Perspective: Why are Doctors so Afraid of Fibromyalgia?

Winfried Häuser
Professor of Psychosmatic Medicine, Technische Universität München, Germany. Specialist in Internal Medicine and Pain Medicine. He is working with FMS patients since 25 years. He is head of the steering committee of the German guideline for FMS and member of the steering committee of the EULAR recommendations for the management of FMS. He is member of the medical board of the German Fibromyalgia Association.

Norwegian physicians ranked FMS on two separate occasions in 2002 and 2014 as the disease with the lowest prestige of 38 „low ranking“ conditions. In my lecture, I will give some very personal explanations for the bad reputation of FMS among doctors.

a) GPs:  Physicians may be poorly knowledgeable in the recognition and diagnosis of FMS.  Physicians are attuned to using objective abnormalities on examination or biomarkers on laboratory testing to confirm clinical diagnoses, a scenario completely lacking in the diagnosis of FMS. Outside of psychosocial and pain medicine, there are uncertainties and reluctance to use symptom-based diagnosis.
b) Rheumatologists: They prefer patients with inflammatory rheumatic diseases for which a broad spectrum of effective drug therapies is avaliable – in contrast to FMS. Rheumatologists are (better) paid for technical investigations than for educating and reassuring FMS-patients.
c) Mental health care specialists: There are still some health care professionals with a narrow psychiatric view on these patients which claim that FMS is an unhelpful diagnosis for the patient and that (masked) depression is the appropriate diagnosis.
d) The FMS community: The rapid change of FMS diagnostic criteria (ACR 2010, 2011, 2016, ACTTION) criteria leave specialists and GPs helpless which criteria to use for the diagnosis of FMS. Scientific controversies in a field can be very stimulating. However, some controversies between the protagonists of a neurobiological and sociological perspective in the FMS community were not helpful at all.
e) Patients: a) A substantial part of FMS patients have experienced childhood adversities and traumatic life events.FMS patients show a higher frequency ofn insecure attachment styles and lower frequencies of  secure attachment styles in comparison with healthy women. Insecure attachment styles increase the risk of interpersonal problems including the doctor-patient relationship. Analyses of facial expressions of interviews with FMS patients demonstrated that elements which stabilize relationships were lacking and that dissociative elements were implanted in the interaction. Doctors (without psychiatric knowledge) experience (some patients) with FMS to be time-consuming and stressful. Some FMS patients provoce a negative counter-transference of the doctors. b) The powerful actions of some FMS self-help organisations (partially supported by pharmaceutical companies) claiming that FMS is a somatic disease deserving disability pensions has raised resentments by insurances, pension providers and physicians providing medical expertise.