Wednesday, February 3, 2010

Fibromyalgia--Is it Real?

Every Tuesday, I conduct a diagnostic clinic at the University of Arkansas. This clinic sees patients referred throughout the state with complex or hard to manage medical problems, or patients that the referring physician is not sure who to turn to for advice or answers.

One of the most common problems I see is a patient with diffuse, hard to categorize soft tissue pain. Most of the patients have a diagnosis of "fibromyalgia". The patient that I saw this week told me her physician sent her to our clinic because "he doesn't believe fibromyalgia is real". Physicians often become frustrated with these patients because the pathophysiology of this condition is not well understood, and because effective treatment takes time and patience. The physician cannot rely on brief office visits and prescription refills to adequately address the issues of most fibromyalgia patients.

Fibromyalgia is very real and is a common problem in practice. Any busy primary care physician will attest to the fact that a significant number of patients with this condition visit our office every week. Fibromyalgia is a rheumatic condition whose characteristics include widespread muscle and joint pain and fatigue as well as other symptoms. Fibromyalgia can, and often does, lead to depression and social isolation because patients are so uncomfortable and fatigued. Patients with chronic fibromyalgia are often really miserable and need the help of a competant, sympathetic physician. Patients with fibromyalgia often complain of "total body pain". They almost universally have great difficulty sleeping. Most have tenderness when you press on the muscles of the upper back and shoulders. Females are 10 times more likely to complain of these symptoms than men.

How well do patients respond to treatment? I have yet to find a single patient who responds quickly or dramatically to any treatment. Rather, they tend to gradually improve with effective treatment of sleep and depression and tend to improve with stretching and exercise and, occasionally, with certain medications.

There are no blood tests, biopsy findings or imaging studies that confirm the diagnosis of fibromyalgia. This lack of clarity and specificity has led many to assert that this diagnosis is "not real". But many patients, mostly middle aged women, have chronic, diffuse, muscle and soft tissue pain and they all need help managing this condition.

The best treatment approach for those who suffer from this problem includes drugs, as well as alternative remedies and lifestyle habits that may help decrease pain and improve sleep. Medications include antidepressants to help alleviate the pain, fatigue, depression, and anxiety that comes with the disease. In addition, your doctor may recommend physical therapy, moist heat, regular aerobic exercise, relaxation, and stress reduction to help you self-manage your symptoms. There is no one "pill" that treats or cures fibromyalgia. A multidisciplinary approach that uses both medication and alternative or lifestyle strategies seems to work best. Medications that help in certain patients include Cymbalta, Savella, and Lyrica.

Patients with fibromyalgia badly need a compassionate, patient primary care provider who can see the patient at regular intervals and who will take a multidisciplinary, long-term approach to managing this condition.