What you should know about Fibromyalgia
Fibromyalgia is defined as a disorder characterized by widespread pain in your body present for more than 3 months and it is not caused by another known condition. It can be accompanied by fatigue, sleep, memory, and mood issues. (1)
When I first started practicing medicine in primary care, I had several patients come into the office with their main complaint being a history of unknown pain. They had already been seen by a pain medicine doctor or rheumatologist. They all shared a history of being seen by their doctor, sent many routine labs and maybe some imaging studies, like an x-ray. They had been given treatment with different type of drugs to treat pain, and the conditions that came along with it, like depression or problems sleeping. Most of them would still not feel well and felt that nobody had being able to tell them what their true condition was or how to properly treat them. One of those had come to the office without an appointment, requesting to be seen because she was in a lot of pain. I had her come in and sit so she would explain to me what was going on. As she was sitting in front of me, tears started to roll down her eyes, she yelled at me saying ‘’how come no one knows what I have, and nothing is working!’’. I was speechless, I sympathized with her but could not help to also feel incompetent and shared her hopelessness in not being able to provide answers or as she had stated, a treatment that works.
This is not uncommon. What patients go through when they first go to their doctor for this type of symptoms. Many share a similar trait on how that goes. (2)
What patient’s with Fibromyalgia go through on a regular medical visit?
As I started to do more research and interviewing many patients with the same conditions, they would all share a common approach and how they had been diagnosed with Fibromyalgia. They would be initially poorly interviewed by their doctor, then given many labs and imaging to do. All the test results would come back negative and the person would be referred out to a specialist to be given a Fibromyalgia diagnosis or to be given treatment. If treatment was not working, they would continue to provide different medications and even refer out to other specialties like psychiatry. Repeating the cycle where it leaves patients confused looking for more answers or having to settle and come to terms with living with pain for the rest of their lives. Most of the treatment options are pain medications and sometimes combined with antidepressive drugs to help cope with the depression that is caused by living in constant pain.
Now, why does this happen very commonly and why are patients not given a better approach or a better solution? It seems that diagnosing Fibromyalgia is not as easy as we would like. It is still a condition with an unknown cause. While there isn’t a specific culprit but rather a combination of factors that can contribute to this, currently, diagnosing Fibromyalgia is now simpler and does not involve having several tender points in specific areas in the body.
Diagnosing fibromyalgia is not as clear as one would like and currently the most widely used criteria for diagnosis is:
to have severe pain in 3 to 6 different areas of your body, or you have milder pain in 7 or more different areas. The symptoms have stayed at a similar level for at least 3 months and no other reason for your symptoms has been found.
Classifying pain is not easy. Patients might express pain differently or have different tolerance levels. That is why it’s important to have a person explain in their own words what type of pain they experience and any other details that comes along with it. (4)
Pain in Fibromyalgia is not the same.
Pain can vary from one person to another. It can vary on severity, what triggers it and the type of pain as well. I’ve had patients that would describe their pain as being dull, it would not get worse with movement or to the touch and it would not go away with medication. I’ve also had other patients describe their pain as sharp, it would get worse with movement and excruciating if they were to be touched. Medications would help but only at high doses and taken in combination. Other patients would explain how pain would also be present in other parts of their body, like their face and how they would have auras and would anticipate when they were about to experience an episode. This does not mean it might be Fibromyalgia on its own, but this is a very good example how other underlying conditions can coexist and contribute to the pain. (5)
As we can see, there are different experiences and different ways on how to interpret what a patient feels and goes through. What is key is how disruptive this is in a person’s life and how it slowly renders them not functional. Just prescribing medications for the pain alone is not an adequate solution. The other symptoms present also must be taken in consideration.
Other symptoms present in Fibromyalgia
Patients that have been diagnosed with Fibromyalgia have also experienced other type of symptoms other than pain. These can also be:
· Fatigue
· Insomnia or difficulty sleeping
· Brain fog
· Depression
· Menstrual irregularities
· Morning stiffness
· Numbness or tingling on extremities
All these symptoms sometimes appear before, during or after the patient started experiencing pain. I believe these are key in helping us find the root cause. They require other type of labs or questioning to have a clear view of how they play a role in other conditions that are commonly present in a person with Fibromyalgia.
What conditions may accompany Fibromyalgia?
Almost on every page that talks about Fibromyalgia, it will always have a section that will list what conditions commonly coexist with this condition. Some of these are:
· Irritable bowel syndrome (3)
· Chronic fatigue syndrome
· Migraine and other types of headaches
· Interstitial cystitis or painful bladder syndrome
· Temporomandibular joint disorders
· Anxiety
· Depression
· Postural tachycardia syndrome
Most of the time, all these other conditions are not seen together as a whole but rather just as other problems that will be delegated to another specialist. What is important is to see the bigger picture and how they play a role in Fibromyalgia. A lot of these conditions may have an autoimmune cause, which means that the body is attacking itself. That changes completely how we would approach this problem and, instead of just providing symptom relief, we can try many treatment options to battle the underlying cause.
What is a new approach in treating Fibromyalgia?
Fibromyalgia has been around for a long time and the way it has been treated has not provided positive results for most patients. The approach needs to be personalized and a more thorough exploration needs to be provided. What do I mean by this? Before we talked about how a conventional approach leaves patients not satisfied with the diagnosis and/or treatment. Most of the time they are just given medication treatment for their symptoms and referred out to other specialties or primary care provider to continue dispensing their medications. On the other hand, a new approach with functional medicine has been providing better results with these patients. Finding the root cause of their pain and other symptoms, providing long lasting results and helping patients participate actively in their treatment. There is little to no side effects because we look for and treat unknown toxicities, undiagnosed infections, poor nutrition and hormone imbalances. These are overlooked in the conventional model and many physicians are not commonly trained. I would know since
The approach in Functional Medicine?
We can take that same patient and have them go through a whole different experience. One that involves them in their diagnosis and treatment, one that gets them closer to feeling better and most importantly, start to learn what is the root cause of their condition. My first patient was a 40-year-old woman who had a history of been struggling with pain for many years and after having visited many specialists, the diagnosis given was osteopenia, which is low bone density, and Fibromyalgia. When I first interviewed her, we started to talk about all her underlying conditions and the ones that had begun even before her pain had started. It seems she had been struggling with GERD and IBS for many years since her teenage years. She had already visited many GI doctors who had routinely done several endoscopies and prescribed medications to provide relief of her symptoms. She had tried many restrictive diets with few results and taken all types of probiotic supplements. Without even focusing on just the paint, we started with a combination of conventional lab work and many advanced testing that she had never heard of before. We were able to assess her nutritional state, her food intolerances and present infection in her gut and overall inflammation. The exams revealed she had hypothyroidism due to autoimmunity, which was triggered by having a leaky gut due to lack of beneficial gut flora and being intolerant to wheat. She had been tested before for all this, but the exams ordered were not interpreted adequately and were also not complete. This allowed us to focus on these main problems and treat them. The patient slowly felt better and even though not all her issues were immediately corrected, she was walking in the right direction.
Conclusion
While it is true that all symptoms may never go away, there is much we can do to start living better. We, as a society, have slowly started getting used to thinking that pain and chronic conditions are normal and that we all will start suffering from them due to age, genetics, old injuries, or a combination of these. We must take a step in the right direction, find more treatment options and work actively in living a better life. It is worth the effort to do everything in your power to try and live pain free.
1. Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management. Firdous Jahan, Kashmira Nanji, Waris Qidwai, and Rizwan Qasim Oman Med J. 2012 May; 27(3): 192–195.
doi: 10.5001/omj.2012.44
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/
2. Facts and myths pertaining to fibromyalgia Winfried Häuser, Department Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany. Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany; Mary-Ann Fitzcharles, MD. Mary-Ann Fitzcharles, Division of Rheumatology, McGill University Health Centre, Quebec, Canada, Alan Edwards Pain Management Unit, McGill University Health Centre, Quebec, Canada;
Dialogues Clin Neurosci. 2018 Mar; 20(1): 53-62.doi: 10.31887/DCNS.2018.20.1/whauser
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016048/
3. Fibromyalgia: the gastrointestinal link Daniel J Wallace 1, David S Hallegua Curr Pain Headache Rep. 2004 Oct;8(5):364- doi: 10.1007/s11916-996-0009-z.
https://pubmed.ncbi.nlm.nih.gov/15361320/
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