Shared Appointments Work for Fibromyalgia Patients

By Benjamin Abraham, MD

Shared medical appointments (SMAs), or group visits, have become a recognized form of care today for patients with many medical conditions. Earlier this year, our Cleveland Clinic Pain Management physicians teamed up with colleagues in Rheumatology and Neurology to offer group visits for patients diagnosed with fibromyalgia. Group visits have been shown to improve pain control and eliminate long wait times.

The research tells us that part of the reason patients benefit from shared medical appointments is because of the support of others suffering with the same issues. Patients often feel like they are the only one with this unique set of issues. Fibromyalgia, a poorly understood painful condition, often results in social isolation. SMAs can help patients to feel less alone with this disease.

Studies have shown greater patient satisfaction, increased likelihood of return to work, and lower pain scores with SMAs. In one 2011 study, a half-day interprofessional fibromyalgia clinic treatment program was positively rated overall, and patients had a modest improvement in fibromyalgia symptoms over a two-year period. (Jones KD, Bennett RM, Ward RL, Deodhar AA. Am J Phys Med Rehabil. 2011 Oct;90(10):825-33.)

How our SMAs work

A group of fibromyalgia patients meets with a pain management physician or a rheumatologist for 60 minutes. During that time, we discuss the science behind fibromyalgia, what is known and unknown about the disease, and we explore commonalities that the patients share. Patients are often surprised to hear about the common features found in the disease, including:

• Migraines
• Constipation +/- diarrhea
• Cognitive difficulties, which patients often call “fibro fog”
• Anxiety +/- depression
• Imbalance due to postural orthostatic tachycardia syndrome (POTS), a condition in which a change from lying to standing causes an abnormally large increase in heart rate
• Fatigue and exercise intolerance

We discuss mimickers of fibromyalgia, such as medical sleep disorders, thyroid disease, lupus, rheumatoid arthritis, and polymyalgia rheumatic. We talk about what works for the treatment of fibromyalgia and what has been shown to be harmful.

Separating the junk science from the effective treatments is important in any disease, but especially in the diseases that are not yet fully understood. It is also important for our patients to be armed with good information to share with their families so they can understand the condition too.

These patients then do a 60-minute group therapy session with one of our pain psychologists specializing in fibromyalgia. These non-medicine treatments have been proven to help patients with this type of pain.

The wait times for a pain management appointment can sometimes be long. Since these appointments are conducted in groups, with two locations currently running (and a third location being added soon), there is little to no wait time to see a physician for these patients.

Education is a critical component of any pain management treatment. Patients feel hopeful and empowered to get better once they are armed with the knowledge they gain in these group appointments. We are getting positive feedback on our patient satisfaction surveys, and moving forward, we will continue to roll out SMAs for patients with fibromyalgia in more Cleveland Clinic locations.

Dr. Abraham is a staff physician in the Department of Pain Management.