It’s estimated that more than 10 million Americans are affected by fibromyalgia, and the condition afflicts twice as many women as men. While the medical community has made strides in understanding the painful condition, misinformation still abounds on this perplexing diagnosis.
Chad Boomershine, MD, PhD, medical director of Boomershine Wellness Centers and assistant clinical professor of Medicine at Vanderbilt, said improvements in brain imaging have led to a much better understanding of fibromyalgia. Still, the board certified rheumatologist and internist noted some physicians are reluctant to admit any such condition really exists. “Doctors will say they don’t believe in fibromyalgia, then they’ll diagnose patients with it and refer them to me,” Boomershine said. “I compare it to where depression was 30 years ago when a lot of people didn’t believe it was a disease and wouldn’t treat it.” He continued, “It then became a typical disease that every primary care provider now treats. Fibromyalgia will get there too.”
New Name with a Long History
While the term “fibromyalgia” has been around since the 1970s, the condition has gone by a lot of names historically. Boomershine points as far back as the Old Testament in the Bible where Job’s description of widespread pain and poor sleep are consistent with fibromyalgia. Neurasthenia was the diagnosis given to patients with similar complaints in the 1800s, followed by fibrositis. Still, the American College of Rheumatology didn’t classify fibromyalgia as a disorder until 1990.
In a Class by Itself
Boomershine is among a handful of rheumatologists willing to treat fibromyalgia patients. That’s because rheumatology involves treatment of inflammatory diseases. Patients with fibromyalgia present with widespread pain but without the inflammation present in patients with arthritis and other inflammatory conditions.
While chronic body pain is the primary symptom of fibromyalgia, other signs can include moderate to severe fatigue, sleep disorders, problems with cognitive functioning, anxiety and depression, IBS, and more. Symptoms tend to be life long. It also affects half of lupus patients and a quarter of patients with rheumatoid arthritis.
Fibromyalgia often presents following major physical or psychological trauma and is thought to be triggered by a disturbance in a person’s pain processing system. “We believe it’s a neurological condition in which hypersensitivity of nerves cause pain,” Boomershine explained. “Over half of patients can identify a specific stressor that brought it on – emotional stress, illness, or something that happened in their lives. We think people are born with a propensity to develop fibromyalgia, but it may not manifest itself until a stressful event … and because of this abnormality, the body isn’t able to adapt to stress.”
A Learning Curve for PCPs
Since less than 10 percent of the nation’s 3,000 rheumatologists treat fibromyalgia, diagnosis and care typically falls to family doctors. “Primary care providers are doing the lion’s share of the work with these patients, and the tricky thing is that this isn’t a disease that has a test,” said internist Marilynn Michaud, MD, of TriStar Medical Group’s Frist Clinic.
Michaud said fibromyalgia is a common condition among her predominantly female patient base. “Patients often present with fatigue, muscle pain and cognitive dysfunction, and it’s my job to makes sure they don’t have anything else,” Michaud said. Her first task – which can take multiple office visits – is to rule out a handful of possible diagnoses that include rheumatoid arthritis, lupus, statin myopathy, mono, Lyme Disease, thyroid or adrenal abnormalities and HIV. She also examines a patient’s psychiatric history. Half of fibromyalgia patients have a history of depression, and a quarter is actively depressed. Many suffer from sleep apnea or a lack of restorative sleep, or experience restless leg syndrome. Anxiety and PTSD also are common among patients.
“Fibromyalgia is complex, but it’s no more complicated than a diagnosis like diabetes,” Michaud said. “There are so many co-existing problems that you have to take little bites out of it over many visits.” For many of Michaud’s patients, first steps often include improving sleep hygiene and seeking cognitive behavioral therapy. Regular exercise also is shown to improve muscle pain and releases endorphins to help combat depression. Massage and relaxation exercises like yoga and tai chi also can be beneficial.
No Magic Pill
“People often want a pill to make the pain go away, and it can be frustrating because you can’t do to the work for them,” Michaud said. “We can guide them, but it takes a lot of effort on their part to really fix it.”
Pharmacological treatment often includes anti-depressants, which help desensitize pain receptors. Lyrica, Cymbalta and Savella have received approval from the U.S. Food and Drug Administration specifically for treatment of fibromyalgia, although Michaud estimates that only 30 percent of patients find relief in these.
And while neither Michaud nor Boomershine prescribes opioids for fibromyalgia patients, they say over-prescription remains a problem among providers. “If you look at any neurological pain disorder, you see that opioids don’t work well,” Boomershine said. “Unfortunately that’s the first line of treatment for many physicians. There’s a lot of education that still needs done.”
Hope for Patients
While diagnosing fibromyalgia is often time-consuming, Boomershine said it’s not overly difficult and encourages providers to make an effort to reach an accurate diagnosis.
“It takes a lot of patience on the part of providers because these patients can be difficult to manage and can take a lot of time,” Boomershine said. “The point I make when I speak to providers is that fibromyalgia patients can get better, because a lot don’t believe that’s true. Patients can be treated and go into remission. Many have been told they’re crazy or are never going to get better, and we can give them hope. That’s the biggest impact I can make.”
PHOTOS: Headshots of Drs. Boomershine, Michaud
WEB:
RELATED LINKS:
