Fibromyalgia

[ghost dog]

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As psychiatrists, do you see many patients with Fibromyalgia (FM)?

As a pain physician, I see many of these people for their chronic pain issues. It is very common for this patient population to have a history of sexual and physical abuse in their past , with resulting anxiety and depression. If I can't manage them on my own successfully, I refer them to psychiatry.

Do any of you approach them in a certain therapeutic way?

GD.

 

[OldPsychDoc]

As psychiatrists, do you see many patients with Fibromyalgia (FM)?

As a pain physician, I see many of these people for their chronic pain issues. It is very common for this patient population to have a history of sexual and physical abuse in their past , with resulting anxiety and depression. If I can't manage them on my own successfully, I refer them to psychiatry.

Do any of you approach them in a certain therapeutic way?

GD.

Yup.
Refer to a pain physician.
😀

Seriously--you gotta take the long view. Get them in therapy--any therapy--though of course CBT's been studied, and I think a lot of us find DBT helpful, since they often have these past abuse/immature coping/axis II issues that the mindfulness/distress tolerance/emotional regulation training is so helpful with. Medication-wise, it's treat target symptoms as best as you can, get them off opiates and benzos as much as you can, get them exercising--in a pool if possible--try some acupuncture, maybe if they can access that.

 

[whopper]

I believe the disorder is real only because I had a number of patients do what is supposed to be done in the disorder-excercise, not use it as an excuse to lose responsibility over their own lives, etc. They cite improvement with SNRIs, will do what they're supposed to do, still have sensivity to pain, but are willing to not get pain meds for the right reasons.

Consider ruling out Lyme disease, as a number of patients with fibromyalgia like sx actually have or had Lyme disease with permanent sequelae.

I do what OPD reccomended in addition to an SNRI or Lyrica. I also do not enable the sick role.

 

[ghost dog]

I believe the disorder is real only because I had a number of patients do what is supposed to be done in the disorder-excercise, not use it as an excuse to lose responsibility over their own lives, etc. They cite improvement with SNRIs, will do what they're supposed to do, still have sensivity to pain, but are willing to not get pain meds for the right reasons.

Consider ruling out Lyme disease, as a number of patients with fibromyalgia like sx actually have or had Lyme disease with permanent sequelae.

I do what OPD reccomended in addition to an SNRI or Lyrica. I also do not enable the sick role.

When you say "to not enable the sick role", do you mean avoiding long term disability? Having the pt not use FM as an excuse to avoid doing household chores etc? or something else entirely?

 

[whopper]

Some patients when diagnosed with an illness demand medication only as a treatment. Sometimes they also regress into a the sick role, along the lines of a factitious disorder, though in this case, the patient would really have an illness. In other words exagerating their illness so that the illness has created something of a mental leash on them patient.

One of the accepted strategies to treat fibromyalgia is to take on life strategies to empower the patient such as CBT, excercise etc.