Fibromyalgia and Medical School

Burrell College of Osteopathic Medicine
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foreseen

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I've been experiencing a great deal of back pain for a while, which I blame on a bad mattress. A general lack of energy, which I blame on not having enough physical activity in my daily routine. I also have a difficult time falling asleep and waking up in the morning, I blame this on my job at a sleep lab where I work about 10 hours a night a few times a week. My grandmother and my father have also suffered for a great deal of back pain, neither of them are over weight and they haven't been diagnosed with anything regarding the pain.

I'm in my early 20's and was surprised to see my symptoms match those of fibromyalgia, and that there is a possibility of family history. I know that a lot of medically informed people think that fibromyalgia is not a real condition, that it can be attributed to bad habits. I'm not usually overweight and almost never eat fast food. I don't have bad posture issues. I don't smoke or do drugs, I don't even use Tylenol for anything less than almost-unbearable pain. I recently gained some wight, but am working on getting it back down with diet and exercise. I don't know enough about it but really hope it isn't real, or at-least that I don't have the disease. I'm looking forward to starting medical school this year and eventually a fulfilling career.

I haven't been diagnosed, but reading about fibromyalgia online is scaring me. I don't currently have medical insurance so I can't see a doctor. If exercise and a better mattress doesn't fix my current condition, I might not be able to work full time as a physician. I don't like to take medication to mask problems, I really hope I can fix this pain my self by getting a better bed and exercising. I've seen my grandmother suffer greatly, she lived in a third-world country so I'm not surprised that she wasn't diagnosed with anything.

What do you guys think about this? Do you feel that my coarse of action will take care of my problems? Do you believe that fibromyalgia is a real condition? If so, do you feel fibromyalgia sufferers can have demanding careers?

Thanks,

Foreseen

p.s. I'm not a hypochondriac and I don't try to diagnose myself for every little physical discomfort. I don't think I have fibromyalgia, but the thought of being unable to work after digging myself into almost $200K debt in med school is truly unsettling.
 
foreseen said:
I've been experiencing a great deal of back pain for a while, which I blame on a bad mattress. A general lack of energy, which I blame on not having enough physical activity in my daily routine. I also have a difficult time falling asleep and waking up in the morning, I blame this on my job at a sleep lab where I work about 10 hours a night a few times a week. My grandmother and my father have also suffered for a great deal of back pain, neither of them are over weight and they haven't been diagnosed with anything regarding the pain.

I'm in my early 20's and was surprised to see my symptoms match those of fibromyalgia, and that there is a possibility of family history. I know that a lot of medically informed people think that fibromyalgia is not a real condition, that it can be attributed to bad habits. I'm not usually overweight and almost never eat fast food. I don't have bad posture issues. I don't smoke or do drugs, I don't even use Tylenol for anything less than almost-unbearable pain. I recently gained some wight, but am working on getting it back down with diet and exercise. I don't know enough about it but really hope it isn't real, or at-least that I don't have the disease. I'm looking forward to starting medical school this year and eventually a fulfilling career.

I haven't been diagnosed, but reading about fibromyalgia online is scaring me. I don't currently have medical insurance so I can't see a doctor. If exercise and a better mattress doesn't fix my current condition, I might not be able to work full time as a physician. I don't like to take medication to mask problems, I really hope I can fix this pain my self by getting a better bed and exercising. I've seen my grandmother suffer greatly, she lived in a third-world country so I'm not surprised that she wasn't diagnosed with anything.

What do you guys think about this? Do you feel that my coarse of action will take care of my problems? Do you believe that fibromyalgia is a real condition? If so, do you feel fibromyalgia sufferers can have demanding careers?

Thanks,

Foreseen

p.s. I'm not a hypochondriac and I don't try to diagnose myself for every little physical discomfort. I don't think I have fibromyalgia, but the thought of being unable to work after digging myself into almost $200K debt in med school is truly unsettling.
Click to expand...

A. nobody here is going to be able to Dx you with anything. B. My opinions are still not fully formed on fibro. The patient type with fibro is pretty consistent in my experience. But at the very least those patients are suffering with SOMETHING and they deserve treatment...whatever that tx may be.

As far as med school/working. Is your pain really that significant that you arent functional?
 
It is against the rules of SDN to seek out medical advice on this site. If you really want any advice, you need to see a physician.
 
Colbert said:
It is against the rules of SDN to seek out medical advice on this site. If you really want any advice, you need to see a physician.
Click to expand...

Well, some parts of the OP's post are medical advice issues but not all of it. "Do you think FM is a real condition" and "can people with it have a demanding career" aren't asking for medical advice, per se, and are what the Confidential Consult forum on SDN gets all the time.

OP, I am sending you a PM.
 
Colbert said:
It is against the rules of SDN to seek out medical advice on this site. If you really want any advice, you need to see a physician.
Click to expand...

The poster is not seeking medical advice. The poster is asking about a medical condition being conducive to the demands of medical school and the field of medicine.
 
In my opinion fibromylagia is a wastebasket disease. You have already pointed out several root causes for the pain, but for some reason are ignoring them. You state that you sleep poorly at times due to your night job, you have gained weight, and something about lack of physical activity if I read closely enough.Also, it seems you are a bit anxious which I am sure just compounds the problem. These can all lead to a somatic issue.

I would be willing to bet if you did something about these, that the symptoms would largely subside. Hence, why I think it is a wastebasket disease. But, for some reason this country is obsessed with having a disease for everything. My hunch is, it is because we want something to blame besides ourselves. Not that you are doing that, just saying.
 
sylvanthus said:
My hunch is, it is because we want something to blame besides ourselves. Not that you are doing that, just saying.
Click to expand...

Actually, I think it's because when people are ill, they want a reason for it so that they know what they're dealing with. It's scary not knowing and it's even worse when you feel out of control, which is exactly how some feel when they have symptoms of a nameless condition.
 
I am no clinical expert and I obviously still lack formal training and experience, but I'm EXTREMELY skeptical of fibromyalgia as a legitimate disease. It doesn't surprise me that you found your symptoms matched those of fibro, because the symptoms that "define" that condition are extremely vague and general. So much so, that the diagnosis is one of exclusion. Some day skeptics like me may be proven wrong, and I'm totally open to that possibility, but right now I'm just not buying it.

As far as being able to cope with demanding careers-- there are doctors with severe MS, with seizure disorders, who are legally blind or missing an appendage. Plenty of people find a way to manage their professional lives despite debilitating disease and terribly adverse conditions. If they can do it, certainly a fibromyalgia sufferer can.

Please don't take this commentary as a personal attack on you. My understanding was that you wanted some frank, amateur answers to your questions, so I did my best... I truly do wish you best of luck with your plans.
 
If you're a sleep tech, you should know the telltale sign of fibromyalgia that appears in sleep: alpha intrusion. It shows up in nearly every fibro patient we see here. It would also help to explain your EDS. And there are certainly worse things that fail to disable practicing physicians.

Something about the original post here is very strange to me.
 
Please do not discuss whether the OP has or does not have fibromyalgia or speculate on what medical conditions the OP may or may not have (or what diagnostic workup should occur) - that would fall under the seeking advice category (or giving medical advice).

I'm keeping this thread open for the ongoing discussion of whether people with illnesses or disabilities can work in the demanding career (such as physician).
 
Fibro is just a physical manifestation of depression. It seems to run hand in hand with poly-drug allergy.
 
Just out of curiosity, why do people not think that fibromyalgia exists?
 
fozzy40 said:
Just out of curiosity, why do people not think that fibromyalgia exists?
Click to expand...

In short, the classic presentation of fibromyalgia includes vague, general symptoms (like generalized pain, problems with sleep, fatigue, mood disturbances...) that occur in the absence of clinical findings. As other posters mentioned, the symptoms are very similar to depressive syndromes. Moreover, I know my personal skepticism has developed after meeting many of these patients, and coming to realize how similar they all seem to be as far as affect, ambition, and attitude. Not very scientific, I admit, but just my personal opinion. Maybe my perspective will change through my studies over the next XX years...
 
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True, but just because the symptoms are vague and general (at times) does not mean that the patient does not have true pain. The classic medical model regarding pain that we are taught is that there should be an anatomic or at least radiologic reason for pain. I feel as though people tend to "not believe" patients with fibromyalgia because often times the workup is extensive and negative. In addition, there is often an affective component that makes providers shy away from them.

Yes, it's true that patients with fibromyalgia often have similar symptoms with depression. But unless you truly know the patient, isn't it possible that the patient became depressed as a result of the pain?

As physicians, we have a hard time believing things if we can't see them or understand. With regards to pain medicine, this is a field that we are just beginning to understand and fibromyalgia falls in that category.
 
Hey I'm not saying the condition doesn't exist, only that I am personally skeptical.

I'm not sure if there is anything wrong with physicians clinging to evidence-based medicine. Extensive, negative workups absolutely should raise some questions as to the basis for these syndromes. I understand that pain medicine is an emerging field and there are most certainly large gaps in our understanding, but science is the only tool we have to explore the unknown- and so far the search has come up largely empty.

I think this is a really interesting topic, and I really hope we can hear some other opinions from SDN'ers as well. Thanks to the OP for bringing it up.
 
There actually is some very interesting fMRI data regarding fibromyalgia so there is progress. I'll try to post them later.
 
fozzy40 said:
Just out of curiosity, why do people not think that fibromyalgia exists?
Click to expand...

Because the typical fibromyalgia patient comes of as nothing more than a whiner. It is very off putting. Add that to the fact that basically 100% are depressed and it the "symptoms" seem very similar to the physical complaints of depression.

You just want to shake them and say "snap the fuc out of it and stop your goaddam whining!!!" If I never have to deal with another fibromyalgia patient it would be too soon.

I am very skeptical that it is an entitiy in and of itself. I think that it is overdiagnosed these days. Once a patient has the stamp of fibromyalgia it never comes off.
 
Instatewaiter said:
Because the typical fibromyalgia patient comes of as nothing more than a whiner. It is very off putting. Add that to the fact that basically 100% are depressed and it the "symptoms" seem very similar to the physical complaints of depression.

You just want to shake them and say "snap the fuc out of it and stop your goaddam whining!!!" If I never have to deal with another fibromyalgia patient it would be too soon.

I am very skeptical that it is an entitiy in and of itself. I think that it is overdiagnosed these days. Once a patient has the stamp of fibromyalgia it never comes off.
Click to expand...

I definitely agree with you that these patients can be pretty challenging. However, I think part of the frustration is that many providers aren't sure what options to give them. I also agree that in the 90's there definitely was some overdiagnosis. However, I personally believe that it is a real entity and the science is finally getting there. Here's a pretty interesting study that clearly shows that patients with FM respond differently to pain:

McLoughlin MJ, Stegner AJ, Cook DB. The Relationship between Physical Activity and Brain Responses to Pain in Fibromyalgia. J Pain. 2011 Feb 16. [Epub ahead of
print] PubMed PMID: 21330218.
 
Instatewaiter said:
Because the typical fibromyalgia patient comes of as nothing more than a whiner. It is very off putting. Add that to the fact that basically 100% are depressed and it the "symptoms" seem very similar to the physical complaints of depression.

You just want to shake them and say "snap the fuc out of it and stop your goaddam whining!!!" If I never have to deal with another fibromyalgia patient it would be too soon.

I am very skeptical that it is an entitiy in and of itself. I think that it is overdiagnosed these days. Once a patient has the stamp of fibromyalgia it never comes off.
Click to expand...

I hope to God you are never my doctor. It's a damn shame that as a resident, you can't feel a little compassion for someone in chronic pain.
 
EagerToBeMD said:
I hope to God you are never my doctor. It's a damn shame that as a resident, you can't feel a little compassion for someone in chronic pain.
Click to expand...

🙄

Its okay to be frustrated with your patients. Doctors are humans too.
 
fiznat said:
🙄

Its okay to be frustrated with your patients. Doctors are humans too.
Click to expand...

That was more than frustration. Calling patients whiners because you don't believe in their illness, despite scientific evidence that it exists? That's called being an ass.
 
fiznat said:
As far as being able to cope with demanding careers-- there are doctors with severe MS, with seizure disorders, who are legally blind or missing an appendage. Plenty of people find a way to manage their professional lives despite debilitating disease and terribly adverse conditions. If they can do it, certainly a fibromyalgia sufferer can.

Please don't take this commentary as a personal attack on you. My understanding was that you wanted some frank, amateur answers to your questions, so I did my best... I truly do wish you best of luck with your plans.
Click to expand...

You are right, I was just looking to lower my anxieties about taking out such a huge loan...I am not looking for a diagnosis here, I should've mentioned that on the original post.

The thoughts on FM and it's authenticity are interesting to read. I'm sure the process of getting to a diagnosis of fibromyalgia is frustrating for both patients and their doctors.

BTW Instatewaiter, I've come across patients who whine as well (not FM patients in my experience), but they are usually experiencing pain and discomfort. There are very few people in the world who just complain for no reason. If you're getting paid to deal with the whining, you have a duty to believe their problems are real and to improve their lives, as long as you practice responsibility and constraint while prescribing meds.

Thanks everyone for your responses.
 
foreseen said:
YIf you're getting paid to deal with the whining, you have a duty to believe their problems are real....
Click to expand...

Disagree. I think there is a responsibility to diligence and compassion, but that's not the same thing as believing everything you hear.
 
Get a new matress, one that is a bit firmer (I love my tempur-pedic knock-off). After a few months of sleeping on that you might suprised that your back pain goes away...you aren't nearly as sleepy...you have more energy.

Also you mention that you get plenty of physical exercise but then mention you're overweight. You're too young to start making excuses, imo.

Edit: You MAY have fibromyalgia but instead of jumping to that right away, why not try to fix the things in your life that you KNOW are attributing to your issues?
 
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sylvanthus said:
What scientific evidence? It is a wastebasket diagnosis of exclusion.
Click to expand...

McLoughlin MJ, Stegner AJ, Cook DB. The Relationship between Physical Activity and Brain Responses to Pain in Fibromyalgia. J Pain. 2011 Feb 16. [Epub ahead of print] PubMed PMID: 21330218.

This is a pretty good place to start. However, the research behind fibromyalgia is probably a little "over the head" for most medical student since pain medicine and gate control theory is not tradionally taught (in detail) during medical school.

Either way, this study does highlight that the fact that there is a signficant CNS component of fibromyalgia that surrounds the abnormal activation of pain fibers and the perception of pain in the cortex.

Let me know if you have any questions!
 
Don't you know?

Lyrica has been shown to help reduce fibromyalgia flare ups!

Also, a little working out here and there...

Oh, and tack on that SNRI baby!

:laugh:

Every fibromyalgia pt is one that has a concurrent depressive issue, along with pain-seeking tendencies. Anxiety is also one. I think it comes down to chronic issues with sleep. I know I can be in all sorts of pain (and my mood is pretty much sucky) if I don't have a good night's sleep.
 
MLT2MT2DO said:
Get a new matress, one that is a bit firmer (I love my tempur-pedic knock-off). After a few months of sleeping on that you might suprised that your back pain goes away...you aren't nearly as sleepy...you have more energy.

Also you mention that you get plenty of physical exercise but then mention you're overweight. You're too young to start making excuses, imo.

Edit: You MAY have fibromyalgia but instead of jumping to that right away, why not try to fix the things in your life that you KNOW are attributing to your issues?
Click to expand...


I said I don't get enough exercise, I'm trying to get back into it as a response to the weight gain. BTW, what mattress do you use exactly?

You are absolutely right about jumping to conclusions; it's not something I'm hoping for, nor am I convinced that I have it. I don't think there's any joy in being diagnosed with a disease unless there is an absolute treatment or cure for it. It seems people diagnosed with FM don't really gain much from the diagnosis, medicine doesn't seem to take care of all their symptoms. Besides, diagnosed or not, I would have to get a grip on the things I'm dong wrong either way.
 
I feel your pain. I wouldn't listen to the skeptics and naysayers who don't understand FM. They lack compassion because they need to go trough it themselves before they can begin to understand. I was diagnosed just a year ago with Fibromyalgia while studying for MCAT. It felt devastating to get so far in my academic career and then to be hit with such debilitating pain--just flipped my world upside down. Its okay to give yourself a break, I did and I'm feeling much better now. Find support groups in your local community where others can relate to you. Gradually try to exercise being sure not to cause more pain. Take frequent mini breaks with your daily activities. Here's a website that will give you more helpful info to manage your pain:
http://www.fmcpaware.org/aboutfibromyalgia
Your health and quality of life are most important. Just remember medical schools will always be there--there's no rush.

And yes,physicians can work part time if they want. I hope this info finds you well.
 
EagerToBeMD said:
I hope to God you are never my doctor. It's a damn shame that as a resident, you can't feel a little compassion for someone in chronic pain.
Click to expand...
Chronic pain patients are extremely frustrating to deal with. In my own limited experience the course of their treatment always headed in the direction of high dose polypharmacy. So far I've only seen a single case where it was actually warranted and that patient had the imaging to prove it. The rest of them struck me as whiny psychosomatic cases with a low tolerance for any pain whatsoever and the idea of normal as walking around in an opioid induced fog.
 
thepoopologist said:
Chronic pain patients are extremely frustrating to deal with. In my own limited experience the course of their treatment always headed in the direction of high dose polypharmacy. So far I've only seen a single case where it was actually warranted and that patient had the imaging to prove it. The rest of them struck me as whiny psychosomatic cases with a low tolerance for any pain whatsoever and the idea of normal as walking around in an opioid induced fog.
Click to expand...

Just because you can't see it on an x-ray doesn't mean it doesn't exist.
 
fozzy40 said:
Just out of curiosity, why do people not think that fibromyalgia exists?
Click to expand...

UGH, I totally HATE the term. So tired of folks trying to get disability and not have to work. I refer to it as the "F" word. I don't deal with it, I don't chart it, Most people are really low on vitamin D and you would be surprised as to how much pain and fatigue can be eliminated with mega dose replacement.

It's hard for me to have empathy when I have my own issues with pain everyday, yet I get up and go to work and deal with the FM crew who want to be paid to stay home.
 
tell them to:

get better sleep, move to Arizona, take a hot bath. boom, FM = cured.
 
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