Is Fibromyalgia Real? 4 Ways to Treat It
Why is it that some doctors doubt this condition? What can be done about it?
Rob Lamberts, MD
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Is Fibromyalgia Real? 4 Ways to Treat It
Today’s podcast will be about a condition that some physicians put in the same mythical category as unicorns, bigfoot, and honest politicians. It is a condition that I see quite a bit in my practice, yet there is nothing about it to see. It is a mysterious thing, the condition known as fibromyalgia.
What Is Fibromyalgia?
Fibromyalgia affects about 2% of the population, which may not seem like much, but actually equals the entire population of Massachusetts or Indiana. It occurs in a female to male ratio of 9:1. The main symptom people with fibromyalgia have is pain. They hurt all over. The pain is mostly in muscles, and muscle pain is what the word myalgia refers to, but the pain can occur in some joints as well. The pain is often localized in small “trigger points.” In fact, the classic diagnosis requires a certain number of these trigger points to be present on exam.
The other main symptom that is nearly universal in fibromyalgia is fatigue. People feel like their plug has been pulled from the wall. These two symptoms have a huge impact on the person’s ability to function on a day-to-day basis.
How Is Fibromyalgia Diagnosed?
So why is fibromyalgia considered mythical by some clinicians? It’s because there are no blood tests, x-rays, or other studies that prove the diagnosis of fibromyalgia. The diagnosis is wholly dependent on the symptoms of the person who has it, which is why it is referred to as a syndrome. Syndromes are problems described by a group of symptoms–and symptoms are what the patients feel, not what the doctor sees on a test. We doctors like it a lot better when we can prove or disprove something with a test. That is because symptoms aren’t always reliable; people can exaggerate or downplay them, or they can even make them up entirely.
The Link Between Fibromyalgia and Depression
Additionally, fibromyalgia has a strong association with major depression. That makes sense, as people who are in pain and tired all the time are going to be depressed more than those who aren’t. But it also casts some negative light on the reliability of the patient’s ability to accurately assess their symptoms.
Is Fibromyalgia Real?
What do I think? Having taken care of many fibromyalgia patients in my years of practice, I believe it to be very real. I have seen people suffer from the pain and fatigue, and have seen many respond well to treatment, as long as I was willing to stick by the patients for the long haul. Just because there are no tests to prove a diagnosis doesn’t mean it’s not real. You can’t do blood tests to prove fear, optimism, or love, but nobody would deny that they are real.
What Causes Fibromyalgia?
What causes fibromyalgia? There are many theories, but most see it as a malfunction in the way that the person’s body deals with pain. Our bodies have all sorts of sensations bombarding it at once. As I sit here, my socks are pushing on my ankles, my shirt is on my back, my neck is a little sore, and my nose itches a little. Most of these sensations are filtered out by the brain, as I want to do more with my day than deal with socks and itchy noses. People with fibromyalgia have something wrong with that filtering mechanism; they seem to feel more of the aches and pains that other people’s brains filter out.
Certainly there is an emotional component as well. As I already said, people with fibromyalgia tend to become depressed; but studies show that depressed people have a much harder time dealing with pain. Cancer patients with real pain will have that pain reduced with treatment of depression. Why is this? Pain is felt in two places. Nerves transmit sensation from the skin, muscles, and other body parts to the brain. But pain is really interpreted and felt in the brain itself. When you take pain medications, most of them do their work in the brain, not on the nerves going to the brain.
How Is Fibromyalgia Treated?
So the real goal of treating fibromyalgia, in my experience, is to reprogram the way the brain filters pain. How is this done?
Improving sleep – a very high percentage of people with fibromyalgia have problems sleeping. Even if they fall asleep, they don’t feel like they get a good night’s sleep. I find that simply helping the person get better sleep improves symptoms significantly. This is generally done using medications, of which my favorite is the muscle relaxant cyclobenzaprine, or Flexeril.
Exercising – doing mild to moderate exercise seems to reduce the amount of pain in people with fibromyalgia. Some people find massage therapy or physical therapy helps, while others do low-impact exercises like water aerobics. I don’t recommend weight lifting or running a marathon. If the goal is to reduce pain, these are not good ways to do that.
Medicating – there are a few new medications specifically aimed at fibromyalgia that seem to help a significant percentage of people with it. Most of these drugs act on the brain, and many are antidepressants or are closely related to antidepressants.
Treating depression – even if it is caused by the fibromyalgia, depression will make recovery very difficult. Taking medications for depression may help, but don’t forget about psychotherapy or other forms of counseling.
A Few Last Words on Fibromyalgia
Before closing, I want emphasize a few very important points. First, fibromyalgia is a chronic problem, meaning that it lasts a long time–usually for years. It tends to wax and wane in severity, and so needs to be treated with patience. There are no “magic bullets” to cure it. In my experience, recovery takes time, patience, and perseverance.
Finally, I strongly advise against using narcotic pain medications to treat fibromyalgia. It does not respond well to them, and the long-term use of them can easily lead to dependency and addiction. If you aren’t getting the help you need from your doctor, find a rheumatologist with experience in fibromyalgia.
If you have topics that you want me to cover, send them to housecalldoctor@quickanddirtytips.comcreate new email, or you can submit them to me on twitter or my Facebook page.
Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!
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