Fms

[101N]

Snipped from a newspaper in Attleboro, MA. What's wrong with this picture?

http://www.thesunchronicle.com/articles/2011/08/16/news/10019231.txt

News
A painful battle
BY RICK FOSTER SUN CHRONICLE STAFFTuesday, August 16, 2011 2:11 AM EDT


Norwood Hospital Pain Management Center patient Jayne Siteman, said of her doctor, Christopher Hummel, "He hasn't given up on me."


With aging population, pain centers growing at area hospitals
NORWOOD - For Jayne Siteman, the battle against pain has been a 13-year litany of aching ribs, swollen feet, headaches and exhaustion relieved only occasionally by prescription medication and injections.

For the last two years, however, Siteman, 55, has been receiving specialized pain care at Norwood Hospital's Pain Management Center and understanding from pain specialist Dr. Christopher Hummel.

"He hasn't given up on me," said Siteman, who suffers from fibromyalgia. "I don't know what I would do if I wasn't referred here."

As the population ages more and more Americans like Siteman are encountering chronic pain either as the result of injuries or diseases like cancer or from non-specific or difficult-to-identify causes. In response, many hospitals such as Norwood and Sturdy Memorial Hospital in Attleboro have created dedicated pain centers that concentrate on chronic pain as a medical discipline.

Siteman, a former building specialist with the Foxboro School Department, had to stop working eight years ago because of crippling pain. Gardening and yard work, two of her loves, fell by the wayside. Yet her treatments and monthly visits with Hummel give her hope for the future. Jayne Siteman had to give up her job in the Foxboro School Department due to chronic pain from fibromyalgia. (Staff photo by Mike George) "I have my better days," she says, "and days when I don't get out of bed. You have to have hope."

Siteman and her doctor have tried a number of approaches, including pharmaceuticals, pain-blocking injections and even a spinal cord stimulator, with varying degrees of success.

Hummel says his goal for most pain patients is to restore them as much as possible to optimum functioning.

"I don't believe we completely eliminate pain," he said.

A major difficulty in treating patients who suffer from chronic pain and pain from unexplained sources is that therapies that show results for a while often stop working.

"Sometimes it seems to wear off," Hummel said. "So we have to look for some other approach." Pain, whether from an accident, disease or aging joints or unknown causes is widespread phenomenon that amounts to a major expense on the nation's health care tab according to a recent report by the Institute of Medicine.

Each year, at least 116 million adult Americans experience chronic pain that equates to between $560 billion and $635 billion in costs annually, says a new report from the Institute of Medicine. Much of the pain is preventable or could be better managed, added the committee that wrote the report.

The committee called for coordinated, national efforts of public and private organizations to create a cultural transformation in how the nation understands and approaches pain management and prevention.

According to the report, pain is experienced uniquely by individuals and that treatment often requires a combination of therapies and techniques.

The report also concluded that pain is more than a physical symptom and is not always resolved by curing the underlying condition. In some cases persistent pain can cause changes in the nervous system and become a distinct chronic disease.

People's pain experience can also be influenced by genes, cultural attitudes toward hardships, stress, depression, ability to understand health information, and other behavioral, cultural, and emotional factors, the IOM study said. Successful treatment, management, and prevention of pain requires an integrated, approach that responds to all the factors that influence pain, it concluded.

However, health care insurers do not treat pain care uniformly leaving some care un-covered.

The report calls on Medicare, Medicaid, workers' compensation programs, and private health plans to find ways to cover interdisciplinary pain care.

The report also concluded that pain warrants a higher level of attention and resources within the National Institutes of Health. The report recommends that NIH designate a lead institute to move pain research forward and increase the scope and resources of its existing Pain Consortium.

The IOM study also said not all health care organizations are set up to deliver integrated pain care.

Norwood, which has had a pain care specialty for several years, recently moved pain management into a new center within the hospital staffed by a team of doctors and specialists.

"Pain management, up until recently, had not been considered a specialty unto itself," said Dr. Allison Gorski, medical director of the center. "But it is and we're way ahead of the curve in that regard."

The center coordinates the coordinated efforts of pain doctors, a pschiatrist and nurse practitiouners and social workers to create personal treatment plans for patients using medical, psychological and lifestyle practices.

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Members don't see this ad.

 

[geauxg8rs]

Novel approach to treating Fibro. why no pump?

 

[jsaul]

Novel approach to treating Fibro. why no pump?

because they won't make any money on the pump refills

 

[101N]

The US disability system is broken and needs fixing.

http://www.nytimes.com/2008/01/14/health/14pain.html?pagewanted=all

<snip>

Fibromyalgia is a real disease. Or so says Pfizer in a new television advertising campaign for Lyrica, the first medicine approved to treat the pain condition, whose very existence is questioned by some doctors.


Jamie Rector for The New York Times

Lynne Matallana, who says she has fibromyalgia, said the drugs would aid acceptance.


Pfizer

Pfizer has started a television advertising campaign for the drug Lyrica, the first approved to treat fibromyalgia.
For patient advocacy groups and doctors who specialize in fibromyalgia, the Lyrica approval is a milestone. They say they hope Lyrica and two other drugs that may be approved this year will legitimize fibromyalgia, just as Prozac brought depression into the mainstream.

But other doctors — including the one who wrote the 1990 paper that defined fibromyalgia but who has since changed his mind — say that the disease does not exist and that Lyrica and the other drugs will be taken by millions of people who do not need them.

As diagnosed, fibromyalgia primarily affects middle-aged women and is characterized by chronic, widespread pain of unknown origin. Many of its sufferers are afflicted by other similarly nebulous conditions, like irritable bowel syndrome.

Because fibromyalgia patients typically do not respond to conventional painkillers like aspirin, drug makers are focusing on medicines like Lyrica that affect the brain and the perception of pain.

Advocacy groups and doctors who treat fibromyalgia estimate that 2 to 4 percent of adult Americans, as many as 10 million people, suffer from the disorder.

Those figures are sharply disputed by those doctors who do not consider fibromyalgia a medically recognizable illness and who say that diagnosing the condition actually worsens suffering by causing patients to obsess over aches that other people simply tolerate. Further, they warn that Lyrica’s side effects, which include severe weight gain, dizziness and edema, are very real, even if fibromyalgia is not.

Despite the controversy, the American College of Rheumatology, the Food and Drug Administration and insurers recognize fibromyalgia as a diagnosable disease. And drug companies are aggressively pursuing fibromyalgia treatments, seeing the potential for a major new market.

Hoping to follow Pfizer’s lead, two other big drug companies, Eli Lilly and Forest Laboratories, have asked the F.D.A. to let them market drugs for fibromyalgia. Approval for both is likely later this year, analysts say.

Worldwide sales of Lyrica, which is also used to treat diabetic nerve pain and seizures and which received F.D.A. approval in June for fibromyalgia, reached $1.8 billion in 2007, up 50 percent from 2006. Analysts predict sales will rise an additional 30 percent this year, helped by consumer advertising.

In November, Pfizer began a television ad campaign for Lyrica that features a middle-aged woman who appears to be reading from her diary. “Today I struggled with my fibromyalgia; I had pain all over,” she says, before turning to the camera and adding, “Fibromyalgia is a real, widespread pain condition.”

Doctors who specialize in treating fibromyalgia say that the disorder is undertreated and that its sufferers have been stigmatized as chronic complainers. The new drugs will encourage doctors to treat fibromyalgia patients, said Dr. Dan Clauw, a professor of medicine at the University of Michigan who has consulted with Pfizer, Lilly and Forest.

“What’s going to happen with fibromyalgia is going to be the exact thing that happened to depression with Prozac,” Dr. Clauw said. “These are legitimate problems that need treatments.”

Dr. Clauw said that brain scans of people who have fibromyalgia reveal differences in the way they process pain, although the doctors acknowledge that they cannot determine who will report having fibromyalgia by looking at a scan.

Lynne Matallana, president of the National Fibromyalgia Association, a patients’ advocacy group that receives some of its financing from drug companies, said the new drugs would help people accept the existence of fibromyalgia. “The day that the F.D.A. approved a drug and we had a public service announcement, my pain became real to people,” Ms. Matallana said.

Ms. Matallana said she had suffered from fibromyalgia since 1993. At one point, the pain kept her bedridden for two years, she said. Today she still has pain, but a mix of drug and nondrug treatments — as well as support from her family and her desire to run the National Fibromyalgia Association — has enabled her to improve her health, she said. She declined to say whether she takes Lyrica.

“I just got to a point where I felt, I have pain but I’m going to have to figure out how to live with it,” she said. “I absolutely still have fibromyalgia.”

But doctors who are skeptical of fibromyalgia say vague complaints of chronic pain do not add up to a disease. No biological tests exist to diagnose fibromyalgia, and the condition cannot be linked to any environmental or biological causes.

The diagnosis of fibromyalgia itself worsens the condition by encouraging people to think of themselves as sick and catalog their pain, said Dr. Nortin Hadler, a rheumatologist and professor of medicine at the University of North Carolina who has written extensively about fibromyalgia.

“These people live under a cloud,” he said. “And the more they seem to be around the medical establishment, the sicker they get.”

Dr. Frederick Wolfe, the director of the National Databank for Rheumatic Diseases and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.

“Some of us in those days thought that we had actually identified a disease, which this clearly is not,” Dr. Wolfe said. “To make people ill, to give them an illness, was the wrong thing.”

In general, fibromyalgia patients complain not just of chronic pain but of many other symptoms, Dr. Wolfe said. A survey of 2,500 fibromyalgia patients published in 2007 by the National Fibromyalgia Association indicated that 63 percent reported suffering from back pain, 40 percent from chronic fatigue syndrome, and 30 percent from ringing in the ears, among other conditions. Many also reported that fibromyalgia interfered with their daily lives, with activities like walking or climbing stairs.

Most people “manage to get through life with some vicissitudes, but we adapt,” said Dr. George Ehrlich, a rheumatologist and an adjunct professor at the University of Pennsylvania. “People with fibromyalgia do not adapt.”

Both sides agree that people who are identified as having fibromyalgia do not get much relief from traditional pain medicines, whether anti-inflammatory drugs like ibuprofen — sold as Advil, among other brands — or prescription opiates like Vicodin. So drug companies have sought other ways to reduce pain.

Pfizer’s Lyrica, known generically as pregabalin, binds to receptors in the brain and spinal cord and seems to reduce activity in the central nervous system.

Exactly why and how Lyrica reduces pain is unclear. In clinical trials, patients taking the drug reported that their pain — whether from fibromyalgia, shingles or diabetic nerve damage — fell on average about 2 points on a 10-point scale, compared with 1 point for patients taking a placebo. About 30 percent of patients said their pain fell by at least half, compared with 15 percent taking placebos.

The F.D.A. reviewers who initially examined Pfizer’s application for Lyrica in 2004 for diabetic nerve pain found those results unimpressive, especially in comparison to Lyrica’s side effects. The reviewers recommended against approving the drug, citing its side effects.

In many patients, Lyrica causes weight gain and edema, or swelling, as well as dizziness and sleepiness. In 12-week trials, 9 percent of patients saw their weight rise more than 7 percent, and the weight gain appeared to continue over time. The potential for weight gain is a special concern because many fibromyalgia patients are already overweight: the average fibromyalgia patient in the 2007 survey reported weighing 180 pounds and standing 5 feet 4 inches.

But senior F.D.A. officials overruled the initial reviewers, noting that severe pain can be incapacitating. “While pregabalin does present a number of concerns related to its potential for toxicity, the overall risk-to-benefit ratio supports the approval of this product,” Dr. Bob Rappaport, the director of the F.D.A. division reviewing the drug, wrote in June 2004.

Pfizer began selling Lyrica in the United States in 2005. The next year the company asked for F.D.A. approval to market the drug as a fibromyalgia treatment. The F.D.A. granted that request in June 2007.

Pfizer has steadily ramped up consumer advertising of Lyrica. During the first nine months of 2007, it spent $46 million on ads, compared with $33 million in 2006, according to TNS Media Intelligence.

Dr. Steve Romano, a psychiatrist and a Pfizer vice president who oversees Lyrica, says the company expects that Lyrica will be prescribed for fibromyalgia both by specialists like neurologists and by primary care doctors. As doctors see that the drug helps control pain, they will be more willing to use it, he said.

“When you help physicians to recognize the condition and you give them treatments that are well tolerated, you overcome their reluctance,” he said.

Both the Lilly and Forest drugs being proposed for fibromyalgia were originally developed as antidepressants, and both work by increasing levels of serotonin and norepinephrine, brain transmitters that affect mood. The Lilly drug, Cymbalta, is already available in the United States, while the Forest drug, milnacipran, is sold in many countries, though not the United States.

Dr. Amy Chappell, a medical fellow at Lilly, said that even though Cymbalta is an antidepressant, its effects on fibromyalgia pain are independent of its antidepressant effects. In clinical trials, she said, even fibromyalgia patients who are not depressed report relief from their pain on Cymbalta.

The overall efficacy of Cymbalta and milnacipran is similar to that of Lyrica. Analysts and the companies expect that the drugs will probably be used together.

“There’s definitely room for several drugs,” Dr. Chappell said.

But physicians who are opposed to the fibromyalgia diagnosis say the new drugs will probably do little for patients. Over time, fibromyalgia patients tend to cycle among many different painkillers, sleep medicines and antidepressants, using each for a while until its benefit fades, Dr. Wolfe said.

“The fundamental problem is that the improvement that you see, which is not really great in clinical trials, is not maintained,” Dr. Wolfe said.

Still, Dr. Wolfe expects the drugs will be widely used. The companies, he said, are “going to make a fortune.”

 

[pmrmd]

“Some of us in those days thought that we had actually identified a disease, which this clearly is not,” Dr. Wolfe said.

A disease with no histopathological findings? Please.

 

[Apollyon]

A disease with no histopathological findings? Please.

Fibromyalgia, irritable bowel syndrome, chronic fatigue, and interstitial cystitis are all grouped the same in my mind: somatic representations of psychological problems. If cystoscopy is performed on the IC people, they can see something. The irritable bowel folks have diarrhea or constipation (but that right there tells you something).

One thing I knew, though, in South Carolina - fistfuls of Lortab were not the way to treat them.

 

[epidural man]

The overall efficacy of Cymbalta and milnacipran is similar to that of Lyrica. Analysts and the companies expect that the drugs will probably be used together.

A treadmill works as well as these - yet, it's like pulling teeth without lidocaine to get a fibro patient to do it.

 

[geauxg8rs]

Treadmills just cause more pain.

the only time I dont hurt is when I am medicated or asleep.

Please give me more hydro because it is the only thing that helps with sleep, unless I take two soma and a vodka chaser.

 

[Apollyon]

Patient came into the ED as I was going off shift.

Her history...

Bipolar
Depression
Fibromyalgia
Irritable Bowel
Interstitial Cystitis
Schizoaffective D/O

First: she didn't have the "chronic fatigue" - I'm guessing only because she's never yet heard of it.

Second: yes, listed as both "Bipolar" and "Depression".

Third: her complaint? Chronic n/v, but a little worse than usual.

 

[epidural man]

Treadmills just cause more pain.

the only time I dont hurt is when I am medicated or asleep.

Please give me more hydro because it is the only thing that helps with sleep, unless I take two soma and a vodka chaser.

Like I said...pulling teeth