"Well, you know I have fibromyalgia..."
Before I worked in rheumatology those words used to send my internal eyes rolling upward. I would nod professionally and pretend I understood, but inside my reaction would be to label the patient with some sort of psychogenic ailment (meaning, it's all in their head). And most of my colleagues believed the same thing, that anyone who brings forth this fact as a part of their medical history was, well, probably crazy.
And I was guilty of the same thing.
I worked for seven years in neurosurgery as a physician assistant, helping my doctors with mostly spine cases. I got to know a lot of my patients quite well, and I would always hesitate to inform my doctors that the patient claimed to have fibromyalgia. It would taint their view of the patient in a negative way, so I would usually just let the patient inform the surgeon themselves. The reaction was always the same. A polite nod, and then the rolling of the eyes as the physician left the room.
I then worked for 5 years in orthopedic surgery, and the thought process was about the same.
Now I've been a rheumatology physician assistant for a year. I still have much to learn. But I am seeing and taking care of patients with a different frame of mind. These are my patients, and I figure I'm better off believing ALL of their complaints are real, and then treating ALL of their complaints aggressively. Then, if we're still left with some unresolved issues, we can delve into those from a psychogenic standpoint. I think that's what a lot of rheumatologists do. I hope.
Trying to piece together fibromyalgia has been difficult. Wrapping my mind around what I previously thought was a bunch of hooey, and treating it as a real ailment, has been quite a journey. It was after listening to a fascinating lecture by Frederick Wolfe, M.D., a world-renowned expert on fibromyalgia, that I was able to finally wrap my mind around this whole thing.
Hello, my name is Eric. I'm a fibromyalgia believer.
There. I said it.
I think it's real.
I have a slightly different approach, however, and it seems to work for most of my patients.
My approach:
1. Fibromyalgia is real.
2. Fibromyalgia is generalized muscle pain, and it is usually the result of an undiagnosed, or poorly understood autoimmune disease, such as rheumatoid arthritis, lupus, and ankylosing spondylitits.
3. Usually proper treatment of the underlying autoimmune disease helps the muscle pain.
4. Some patients with autoimmune diseases have a lot of muscle pain, some have just a little. It's a spectrum.
5. Many of my patients have been diagnosed with fibromyalgia by their primary care providers. And they accept that and leave their primary care physician's office. But a lot of my patients also have insomnia. If they went to their PCP and said, "I can't sleep", and their PCP said, with a very serious voice, "Well, Mrs. Smith, you have insomnia," she would probably say, "Thank you, doctor, but WHY?" I wish when my patients were diagnosed with fibromyalgia, they would say, "Thank you, doctor, but WHY?"
6. So I basically place fibromyalgia in the same category as insomnia. a lot of my patients have muscle pain, just like a lot of my patients have trouble sleeping. I take their complaints seriously and address them as best I can. I do know that the SNRI's can help quite a bit, and use them frequently to help with the muscle pain my patients have.
7. I do have a couple of patients with true fibromyalgia, and little else to go on as far as a true autoimmune disease. It's a struggle. But those patients seem content continuing to see me because they know I believe them, and I'm not going to give up on them.
Does fibromyalgia deserve to be it's own disease? Well, now that the pharmaceutical industry is involved, we're stuck with it. The FDA blessed it as a disease when it gave some medications indications for fibromyalgia. Millions are being spent every year on medicines and research. Which is good, I suppose.
But does giving "disease" status to something that is more like a "symptom" really help anyone?
Time will tell...
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