Clearwater, Tampa, St Petersburg, Florida
Fibromyalgia is a perplexing and puzzling source of pain for both patients and the physicians who treat them. The reason for this is there is a lot of misinformation about fibromyalgia. Fibromyalgia is what is known as a syndrome – a collection of symptoms. It is not a disease, because there is not a specific medical diagnosis for what is causing the patient’s pain. In other words, we do not know what causes fibromyalgia.
Unfortunately, fibromyalgia patients are often mislabeled with multiple diagnoses, all of which may have pain as a symptom. A potential reason for this is fibromyalgia may actually be an umbrella of multiple, separate disorders all falling under the name fibromyalgia. There are patients who have been diagnosed with rheumatoid arthritis due to their pain, and because they also suffer from fatigue, they are said to have secondary diagnosis of fibromyalgia. There are also patients who have Epstein Bar Virus or other undiagnosed conditions that if treated could readily explain their poor health. All of these factors lead to confusion and unfortunately misdiagnosis and mistreatment in many cases.
The history of fibromyalgia can be traced back to early references to rheumatism, which was treated in a variety of ways, including laudanum, without significant success. In 1904, the term fibrositis was coined by Sir William Gowers, who felt it was a disorder of the fibrous tissue. In the 1980’s, with the advent of the electron microscope, it was found that there was actually no inflammation in the fibrous tissues; therefore, fibrositis fell out of favor. In 1990, the American College of Rheumatology, in an attempt to collect research information on these patients, established a loose set of criteria of wide spread pain, defined as painful palpation at 11 of 18 predetermined sites. This was initially meant to allow a large group of patients to be studied in order to collect research data; however, due to the lack of specificity, there was an escalation in the frequency of the diagnosis. Today, there are many research theories under way to determine the cause (or causes) of the pain involved.
Currently, fibromyalgia cannot be identified by any diagnostic test. Fibromyalgia is found to affect 2-5% of adults in the United States and is more frequent in women than in men. It is considered rare in children.
Patients with fibromyalgia report an overall diminished quality of life and decreased health status. Fibromyalgia patient’s often report their impairments as more serious than reports from patients suffering from osteoarthritis, a herniated disk, or even rheumatoid arthritis. Developing a patient’s treatment and rehabilitation plan addressing quality of life issues is critical. Unfortunately, many fibromyalgia patients are often given the impression that they have an incurable disease that they just need to learn to live with.
Dennis M. Lox, MD,, as a board certified physcian in Physical Medicine and Rehabilitation, focuses on quality of life issues and not just on pain. It is paramount to improve a patient’s quality of life, in order to improve their overall health status. The National Fibromyalgia Association estimates it takes two years for most of these patients to end up with the diagnosis of fibromyalgia, and they undergo seeing three to six physicians, often without any clear information being provided about what the syndrome is or what to expect. This often results in protracted disability, frustration, depression and ineffective treatment.
Numerous medications have been tried, but most have not been successful. Anti-inflammatories and narcotics have not shown to be effective as muscle relaxants, and sedatives have not shown to have any positive effect on improving quality of life. With recent research and FDA approval, certain anti-depressants and neuroleptic medications have shown promising improvement.
Obviously, when a patient has seen numerous physicians and is on numerous medications, it is extremely difficult to improve their quality of life when they are over-medicated. These issues also are critical to address.
The widely accepted measures to help define fibromyalgia are:
1. Chronic pain lasting for more than three months
2. Pain that is widespread above and below the waist and is bilateral or on both sides of the body.
Other symptoms can include sleep disturbances, fatigue and morning stiffness.
The early criteria developed by the American College of Rheumatology of having 11 tender points at 18 predetermined sites has not been found to be useful for many physicians, and consequently the American College of Rheumatology in 2010 issued a new set of criteria for the diagnosis of fibromyalgia. The new criteria is intended to provide a more robust yet brief diagnostic criteria for physicians to arrive at the fibromyalgia diagnosis, allowing physicians to use only their clinical judgment in diagnosing the condition.
Treatment Options for Fibromyalgia
Since fibromyalgia is a collection of symptoms without a specific, diagnosable cause, treatment cannot be focused on the root cause of the pain. Rather, treatment focuses on improving overall quality of life issues by reducing as much pain as possible at the points of pain. In addition to interventional and/or pharmaceutical treatments, life-style adjustments and changes can also have a dramatic effect on improving the fibromyalgia patient’s quality of life.
It is important to remember that research continues into fibromyalgia, and it is defined as a syndrome – a collection of symptoms – without a known pathophysiologic diagnosis. There are multiple theories currently being used to help explain why these particular patients complain of such significant pain and have such a degraded quality of life.
It is important for a caring physician to understand all these issues and to help provide accurate, understandable information. The physician needs to help guide the patient through a treatment process to increase their quality of life and improve their overall well being.
If you continue to suffer with fibromyalgia and your current treatment plan leaves you feeling hopeless, perhaps a fresh set of experienced eyes can change your outlook. Since 1990, Dennis M. Lox, M.D has applied his personal interests in sports medicine, cutting-edge regenerative medicine and chronic pain management to helping patients increase their quality of life. Contact us for an appointment at 727-462-5582.