The “F” word.

Now, now… get your minds outta the gutter.

The “F” word I am referring to is Fibromyalgia.

It’s plagued my office work over the last few weeks.  It’s a diagnosis I hate. It’s difficult to tell a patient they meet the criteria for diagnosis. It’s difficult to manage and impossible to treat (for the most part).

Fibromyalgia (fibromyositis, myositis):Fibromyalgia is a common syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues.   Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, and anxiety. (Source: PubMed Health)

It’s hard enough treating chronic pain, but treating widespread chronic pain, in mostly women, with our without other psychological issues is a whole entire other matter.  It’s not surprising to me that the recommended treatments include medications which also have some mood stabilizing qualities.  But how to explain that to a patient?  “Hi, you have FM.  I’m going to suggest a medication that has been used in the depressed population.”  Um … say again?  “I’m not depressed, I’m in pain.”  Most patients refuse.  Those that don’t often recognize that there is some element of mental health issue that could be playing a role.  Others are adamant that those medications are not for them and insist on being seen by yet another Rheumatologist, or Neurologist, or “pain specialist”.  These patients often have had every test imaginable – x-rays, EMG, MRI, CT.  And for the most part, the results are normal.  I can understand the patient’s frustration – but imagine what it’s like from my perspective???  I have cost the health care system money in diagnosing that there is no pathological cause of their pain.  Yet, they are still in pain.

What does one do?

Some doctors would just start the narcotics, but that’s a slippery slope and never ends well.

Conservative treatment suggests exercise, healthy diet and OTC analgesics (like Tylenol or Advil).  How does one exercise when they’re in pain?  How do you explain to these patients that their pain will get better with mild-moderate exercise?

The thing that gets me the most with Fibromyalgia is the first thing on the list as possible causes (see also: Mayo Clinic) — physical or emotional stress.   There rarely is an individual whom I’ve seen diagnosed with Fibromyalgia who doesn’t have some emotional/psychological trauma in their past. I believe it’s their subconscious way of coping.  It’s somehow easier to describe (and therefore sometimes treat) physical pain rather than emotional/psychological pain.

I am at a loss most times with how to deal with these patients.  I know they are in pain but my options are limited.  I am already beginning to resent the select few who threaten harm to themselves “if you can’t help me”.  What they fail to realize is that I am trying to help them and that sometimes, thoughts of them keep me  up at night.