without a previous diagnosis of fibromy- mined a primary diagnosis of fibromyalgia, algia, and 8% to submit a planned request however, is small. Appointments for the for a medical cannabis license to the Israeli rheumatology clinics are scheduled by the Medical Cannabis Agency, or for request patients themselves without any interven- for a medical cannabis license renewal. The tion of the rheumatologist. Calls for urgent rest had different reasons. appointments are usually accepted regard- Mean age of the fibromyalgia patients less of the reason. In addition, usually ap- was 38.9 ± 12.2 years (range 18–72), fe- pointments for patients with inflammatory male: male ratio was approximately 4:1, problems are scheduled for 3–4 months in 76% had co-morbidities, 7% had second- the future, while patients with other causes ibromyalgia is a common chronic pain ary fibromyalgia to trauma only, and only are asked to schedule an appointment 4–6 Fsyndrome mainly characterized by dif- 27% were employed. Of the patients, 97% months after the last visit. fuse musculoskeletal pain and fatigue [1]. were treated for fibromyalgia with simple Fibromyalgia seems under-reported at The prevalence in the general population analgesics at any time, 81% with simple rheumatology clinics for various reasons, ranges from 2–5% and is generally high- opiates, 43% with either pregabalin or including rheumatologists’ failures to even er among female by a ratio of 8-9:1-2 [2]. cymbalta, 18% with strong opiates, and 9% recognize it and its common categoriza- The pathogenesis of the syndrome is not with medical cannabis. tion, at best, under chronic pain syndrome fully understood. Many theories attempt to Clearly, fibromyalgia comprises the or another diagnosis. Many patients report explain it. The most accepted theory is the most common outpatient primary diagnosis unpleasant attitudes from physicians and centralization theory: the conception of at these rheumatology clinics, leaving oth- difficult interactions, especially at the of- pain at the cortex is over-expressed with er diagnoses far behind, including degen- fices of the ISSA, in the sense of not being a continuous perception of pain. Fibro- erative, inflammatory, and tendon-related believed [4]. These attitudes are reflected by myalgia is associated with physical and problems. This percentage is not surprising the low percentages of disability payments mental disability, which has a great impact given its prevalence in the general popu- granted to these patients by the ISSA. Yet, on society. Even with this high prevalence lation and the lack of effective treatments. due to the great impact of this syndrome on of fibromyalgia in the general population, However, these results could also be biased the afflicted patients, which is expressed by however, there are nearly no data on the by the attitudes of treating rheumatologists objective parameters such as quitting jobs, prevalence of fibromyalgia among pa- toward fibromyalgia, including the issue of unemployment, and divorce in addition to tients attending the rheumatology clinic. prescribing medical cannabis treatment. the emergence of strong lobbies, the ISSA In this letter we summarized the prima- The proportion of these visits that deter- is considering disability compensations for ry diagnoses of the first consecutive 1008 severe cases of fibromyalgia. visits at the outpatients clinics of Meauhe- det (Hadera, Nazareth, and Shefaraam), Maccabi (Nof Hagalil), Laniado Hospital (Netanya), and Nazareth Hospital (Naza- reth). Two consecutive visits of the same patient within 2 months with the same diagnosis were considered as one visit only. Fibromyalgia diagnosis was based on the American College of Rheumatolo- gy (ACR) criteria from 2010 [3]. Table 1 shows the prevalence of different diagno- ses of all 1008 visits. Fibromyalgia was the primary diagnosis and reason for the visit to the rheumatology clinic in 42% of all the visits, followed by tendinitis/tendinopathy in 9.5%, mechani- cal back pain in 7.3%, rheumatoid arthritis in 7.2%, and osteoarthritis in 6.5%. Among the fibromyalgia visits, 55% came for fol- low-up appointments, 23% to obtain a re- port for the Israeli Social Security Agency (ISSA) or for insurance companies, 9%