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  1. Perceptions of Fibromyalgia Syndrome (FMS) in Primary Care PracticeTerence W. Starz, Molly T. Vogt, Francis Solano, Margaret Moore University of Pittsburgh Medical Center, Pittsburgh, PA Results Introduction • Demographics • 56% internists, 42% family practitioners • in practice for an average of 20.7 years ( range 4-46 yrs.) • majority (79%) practiced in a group setting • Beliefs • 78% believe that FMS is a distinct clinical entity • 85% believe that FMS has both psychological and • medical components • Diagnosis • 92% aware of ACR criteria • 56% routinely use the criteria in practice • Lab and Imaging studies ordered • 90% thyroid function studies • 82% complete metabolic profile • Rheumatologic testing - rheumatoid factor (76%), ANA • (76%), ESR (87%), CRP (39%), HLA-B27(2%), CCP (6%) • 36% x-rays, 1% CT/MRI • Medications ordered by 96% • 85% NSAIDs • 79% SSNRIs, 75% SSRIs • 69% tricyclic antidepressants • 66% alpha-2-delta inhibitors • 57% cyclobenzaprine • 46% non-opioids • 33% trazodone • 16% opioids FMS occurs in 5–6% of adults seen by general internists and family practice physicians. However, although the ACR developed criteria for the diagnosis of FMS in 1990, clinicians continue to debate the appropriate diagnostic criteria and management for this syndrome. This study describes the perceptions of PCPs about FMS, its impact on their practice and their specialty referral patterns. • Non-pharmacologic interventions used by 98% • 95% exercise, 91% physical therapy, 66% education • 37% tender point injections, 29% cognitive behavioral therapy • 25% chiropractic, 18% occupational therapy, 17% TENS • 12% acupuncture, 7% herbals. • Referral patterns • 93% use rheumatologists for evaluation and management • referral • 46% pain specialists, 24% physiatrists, 22% psychologists, • 21% psychiatrists • Impact on practice • 33% report that more than 5% of their patients have FMS • 87% report that FMS patients require more time than typical • patients Methods A questionnaire was sent via email or fax to 183 PCPs in southwestern Pennsylvania. 87 PCPs (48%) responded to the survey.Information was obtained on the perceptions of PCPs  about the diagnosis and management of FMS:     - was it a medical or psychological condition    - were the 1990 ACR criteria used in diagnosis    - were laboratory and imaging studies ordered - treatments used - the impact of FMS patients on clinical practice     - office time spent with FMS patients - referral patterns. Analysis was performed using descriptive statistics and chi-square test for comparisons. Conclusions Although PCPs believe that FMS is a distinct clinical entity, only about half use the ACR fibromyalgia criteria for diagnosis. Rheumatologic testing is commonly utilized. Most PCPs believe that rheumatologists should be actively involved in the evaluation and management of FMS patients.