Fibromyalgia – Does everyone have it?

There are several diagnoses that are troubling to me as a pain medicine physician. These are RLS, Migraines, Chronic Fatique Syndrome and Fibromyalgia. I find these troubling because many doctors rapidily diagnose people with these issues and then the patient takes that diagnosis to heart. Also troubling is that these issues are what I call a dumping ground because they don’t have any real treatments except pain medications, except true migraines. Thus people get diagnosed with the disease Fibromyalgia and then there is not real treatment for their problem except to live with the pain and take pills. I feel that this is a disservice to the patient since probably 90% of the people diagnosed with Fibromyalgia don’t really have the disorder. There are specific findings for Fibromyalgia which include trigger points in every quadrant of the body. Thus people with localized pain don’t qualify for Fibromyalgia. People generally have pain all over their body with Fibromyalgia and not just in certain areas. People who don’t fit this criteria should have other potential sources of pain ruled out. In the past, we required around 20 trigger points in various regions to be present to qualify as Fibromyalgia. This is very vague since if you push on most people’s skin, they will have trigger points in various places of their body. Nonetheless, the object here is that fibromyalgia involves the entire body. The patient usually has a burning component to the pain and has been worked up for possible entities such as lupus, lyme disease, psychological issues, hormonal issues, etc. It is vital that other options be ruled out before diagnosing someone with fibromyalgia since the diagnosis of fibromyalgia carries a very poor prognosis and most of the treatments involve medications or minor injections. In my experience, 80 to 90% of the people who come to me with the presumptive diagnosis of fibromyalgia really have some other issue and much of the time, that issue is treatable. It is important to realize that Fibromyalgia is a diagnosis of exclusion, meaning there is no test to confirm that someone has the disease but you give them the diagnosis because they don’t have any other diseases and their symptoms correlate with fibromyalgia. Treatment often includes medications such as Lyrica or Neurontin, which are anti-seizure medications that are utilized to quiet down nerves associated with the disorder. Anti-depressants are also utilized for both their psychotropic effects and their effects on neuro-transmission. They also help with sleep. Narcotic medications can be utilized but generally have a poor response and result in significant escalation to control the pain. These patients often require long term care that includes cooperation with the psychiatrist, primary physician and the pain doctor.

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