Fibro

[50960]

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As a medical psychologist working in primary care, I see alot of fibro pts. What are your opinions about these patients?? Do you see this as a psychosomatic illness, as a solid medical Dx??

PS. Thanxs again Deanwormer😀

 

[salmonella]

As a medical psychologist working in primary care, I see alot of fibro pts. What are your opinions about these patients?? Do you see this as a psychosomatic illness, as a solid medical Dx??

PS. Thanxs again Deanwormer😀

There has always been a debate over whether fibromyalgia is psychosomatic or organic. Based on my clinical experience, I think it's psychosomatic because:
-Symptoms of fibromyalgia often occur at times of psychosocial stress (divorce, family issues, accidents, financial difficulties, etc)
-Fibro patients get symptomatic relief from anti-depressants and sleep agents
-There is no elevation of CRP, CPK and ESR; often times, medical workups are negative
-Fibro symptoms are often associated with lack of sleep
-Regarding the tender point issue: often time fibro patients have generalized back muscle pain anyway. It seems like they feel tender just about everywhere you push

I think psychiatrist/psychologist can offer valuable inputs in management of fibromyalgia patients.

 

[neglect]

Fibromyalgia is simply not a medical condition. I don't believe it to be a psychiatric problem either, although it is obviously linked to mood disorders.

Instead, it is probably best classified as a choice to be miserable. Or, as part of the human condition should a human being become exposed to lack of excercise, sleep, and fulfillment in life with additional use of tobacco, processed food, extra calories, self pity, and stress. Doctors no longer classify homosexuals as having a medical condition. Nor left handers.

FM ought not be a medical condition either and it is unfortunate that it is - because nothing within medicine helps them, anymore than it would 'help' a left hander. It is best handled by psychiatry to address the possible underlying depression and by counselors - for those few patients with the bravery to recognize their problem for what it is and stop seeking magic pills/shots/fairy dust to immediatly cure their 'condition' without addressing the myraid of underlying problems, thus enabling them to continue their unsustainable lives.

Seriously, most humans were not born to never excercise, sit around constantly getting fat, smoke, watch non-stop TV, and have poor sleep habits.

 

[Methyldopa]

FM ought not be a medical condition either and it is unfortunate that it is - because nothing within medicine helps them, anymore than it would 'help' a left hander.

That's not been my experience. SSRI's (with counselling) and Sleep aids often helps these pts a lot.

Fibromyalgia should be as much a medical condition as depression or Munchausen, etc.

 

[neurologist]

There has always been a debate over whether fibromyalgia is psychosomatic or organic. Based on my clinical experience, I think it's psychosomatic because:
-Symptoms of fibromyalgia often occur at times of psychosocial stress (divorce, family issues, accidents, financial difficulties, etc)

Miraines and epileptic seizures are also well recognized to be exacerbated by psychosocial stressors. Ask any migraineur or epileptic "what makes your seizures/headaches happen" and 9 out of 10 will include "stress" on the list. So does that mean that migraine and epilepsy are "psychosomatic"?

patients get symptomatic relief from anti-depressants and sleep agents

So does just about every other chronic pain patient.

- there is no elevation of CRP, CPK and ESR; often times, medical workups are negative

Why should there be elevated CRP, CPK, or ESR? Those are markers of muscle breakdown or inflammation. Fibromyalgia is looking more and more like a disorder of central sensory/pain processing. Labs for peripheral muscle or immunologic disease won't pick that up. Nor will anything else at this time.

-Fibro symptoms are often associated with lack of sleep

Again, ditto for migraine, seizures, etc.

I think psychiatrist/psychologist can offer valuable inputs in management of fibromyalgia patients.

I agree with you here, but again, I think this is true for many flavors of chronic pain, not just FM.

Neurologists better come up to speed on FM, because it's moving slowly and surely away from rheum and into the neuro world. . . . 😱

 

[deleted87716]

Neurologists better come up to speed on FM, because it's moving slowly and surely away from rheum and into the neuro world.

Probably because none of the rheumatologists are taking new fibromyalgia patients. 😉

 

[neurodoc]

Why should there be elevated CRP, CPK, or ESR? Those are markers of muscle breakdown or inflammation. Fibromyalgia is looking more and more like a disorder of central sensory/pain processing. Labs for peripheral muscle or immunologic disease won't pick that up. Nor will anything else at this time.

I recall reading some reports of abnormalities in electrophysiologic and functional neuroimaging (fMRI/PET) studies of patients with FM. If these are valid observations, FM may be an "organic" disorder.

Nick

 

[Nerdoscience]

I remember reading somewhere that the people who coinedthe term fibromyalgia later decided that it was not a true syndrome, but just a manifestation of myofascial pain. Having seen how myofascial pain manifests very similarly in many patients, I can buy that. It is well-known that there is a clear emotional aspect to pain, and that stress and pain can form a positive-feedback loop. This, to me, explains why sleep, exercise, and stress management are the treatments. But, I am far from an expert on the matter.

 

[DeanWormer]

Any thoughts why physiatry (PMR) isn't more involved with the fibro patieints since they are schooled in the applied MSK and Neuro areas? If Rheum wants to punt and Neurology and Psychiatry doesn't want to catch then I say lateral toss to Physiatry/PMR. The Primary care docs are overwhelmed and if all else fails they can always go to nonphysician providers or tune into Dr Phil and buck up. Thanx Psisci 🙂

 

[neglect]

Any thoughts why physiatry (PMR) isn't more involved with the fibro patieints since they are schooled in the applied MSK and Neuro areas? If Rheum wants to punt and Neurology and Psychiatry doesn't want to catch then I say lateral toss to Physiatry/PMR. The Primary care docs are overwhelmed and if all else fails they can always go to nonphysician providers or tune into Dr Phil and buck up. Thanx Psisci 🙂

Rehab is only interested in things that pay, like doing EMGs, giving botox, and various highly paid ortho procedures. Why would anyone want to deal with fibromyalgia patients?