50960

Guest
10+ Year Member
Aug 20, 2004
1,628
4
49
CO
Status
I am getting ready to collect some data, and write an article on fibromyalgia. My job is to collect data on various aspects of the disorder from GP and family docs, and discuss the psych implications based upon the research etc... I have my own opinion based upon experience and training, but wanted to hear what you think, what you have been trained to think etc.

cheers :D
 

ntubebate

Country Doctor
10+ Year Member
Jul 8, 2006
76
0
Status
Attending Physician
psisci said:
I am getting ready to collect some data, and write an article on fibromyalgia. My job is to collect data on various aspects of the disorder from GP and family docs, and discuss the psych implications based upon the research etc... I have my own opinion based upon experience and training, but wanted to hear what you think, what you have been trained to think etc.

cheers :D
Exactly what are you looking for? Could you cite some examples? I treat a LOT of fibromyaliga and treat it very agressively with better than avg. results.

PM me if you like.

ntubebate
 
OP
5

50960

Guest
10+ Year Member
Aug 20, 2004
1,628
4
49
CO
Status
Basically I will be getting at: do you think it is a real medical disease; do you think it is a neurosis/psychosomatic issue; what is your understanding of the distinct dx criteria (IE. is it a r/o disorder only); and how does this relate to myofascial pain syndromes that are well documented. ???

:cool:
 

ntubebate

Country Doctor
10+ Year Member
Jul 8, 2006
76
0
Status
Attending Physician
psisci said:
Basically I will be getting at: do you think it is a real medical disease; do you think it is a neurosis/psychosomatic issue; what is your understanding of the distinct dx criteria (IE. is it a r/o disorder only); and how does this relate to myofascial pain syndromes that are well documented. ???

:cool:
Is it a real medical disease? I ask myself this everyday. I think deep down I do believe that it is a medical disease, simply because of the profound impact that I see it has on peoples lives. Something a rheumatologist friend of mine told me that has always stuck with me; Think about the people with RA and compare them to the people with Fibromyalgia. Both are extremely painful diseases but the people with RA can cope. On that basis alone I have to think that in some regard Fibromyalgia is a psychosomatic complaint and I would go as far as to say that Fibromyalgia may simply be a complete failure of all coping skills. Does this mean that the pain is any less or less worthy of treatment? Certainly not. It does mean that one has to take in to consideration the etiology of the pain and prepare treatments centered around it.

As far as diagnostic criteria, American Acacdemy of Rheumatology sets forth dx criteria which I fully support and follow. I do not consider Fibromyalgia a dx of exclusion but rather a disease which must not be diagnosed until others have been excluded.

In relation to MPS, without a doubt I think Fibro is different. Different pain pathways, different first line treatments and a completely different etiology.

ntubebate
 

Doctor Bagel

so cheap and juicy
Moderator Emeritus
15+ Year Member
Sep 26, 2002
10,919
1,122
from the ministry of information
Status
Attending Physician
ntubebate said:
As far as diagnostic criteria, American Acacdemy of Rheumatology sets forth dx criteria which I fully support and follow. I do not consider Fibromyalgia a dx of exclusion but rather a disease which must not be diagnosed until others have been excluded.
Isn't there some questioning about the validity of the diagnostic criteria? At my last job where we did disability claims, our fibro information stated that the diagnostic criteria had been questioned by other rheumatologists, but I don't know how accurate it is. People in the disability insurance field are very suspicious of fibro, so that could definitely play into questioning the diagnostic criteria.
 

ntubebate

Country Doctor
10+ Year Member
Jul 8, 2006
76
0
Status
Attending Physician
exlawgrrl said:
Isn't there some questioning about the validity of the diagnostic criteria?
Of course there is question as to the validity of the diagnostic criteria! I personally know more than one rheumatologist that questions it, not to mention numerous other physicians that do. There are also rheumatologists that treat fibro with the guaifenesin protocol, herbs and mineral supplements. If you were supposed to be a specialist in an area of disease and had not one single treatment that you could reproduce positive results with, wouldn't you question the diagnosis? Let's face it, Elavil doesn't work for everyone. Cymbalta and Lyrica are showing promise but we're still a far shot of from having an indication on either of those drugs.

As far as most insurance companies being leary of fibro? I again show that we have a "disease" which acts differently in almost every person who has it, isn't present on any diagnostic test and has no reliable treatment. Sounds pretty easy to dismiss If you ask me.

ntubabte
 

PeterG

Member
10+ Year Member
5+ Year Member
Jan 4, 2006
29
0
Status
ntubebate said:
I again show that we have a "disease" which acts differently in almost every person who has it, isn't present on any diagnostic test and has no reliable treatment. Sounds pretty easy to dismiss If you ask me.

ntubabte
This is the problem with Lyme disease too and why patients are often dismissed as being hypocondriacs. The symptoms present very differently in different people. Some people have mostly psychiatric symptoms and others have mostly arthritis symptoms (I am simplifying of course but you get the point...).

And just like fibro there aren't reliable tests for Lyme. A lot of people with late stage Lyme test negative on standard Lyme tests but they are indeed sick. And there isn't one standard treatment protocol for Lyme either. The treatment can vary widely from person to person.

But given all that it doesn't mean that Lyme or Fibromyalgia aren't real diseases.

Sorry to digress from your thread....