Fibromyalgia is a disease causing widespread real musculoskeletal pain. Epidemiology studies indicate 1.5% to 6% of Americans (3 to 6 million people) suffer with fibromyalgia.1, 2
Study published by Harris RE in 2006 was titled as “How do we know that the pain in fibromyalgia is real.”3 Study suggest gene mutation and neurobiological abnormalities in brain causes fibromyalgia. Fibromyalgia is a clinical diagnosis, which is often not supported by definitive diagnostic lab test and image studies. But recent scientific study published by Elvin Et al (and others) in 2006 compared muscle blood flow of 10 patients diagnosed of fibromyalgia with 10 normal patient.4 The scientific study suggest patient suffering with fibromyalgia had muscle ischemia and muscle ischemia caused pain symptoms. Several similar studies indicate fibromyalgia is a real disease though diagnostic criteria are widely debated.4 Fibromyalgia does cause real pain.
Which are the Medications Prescribed in Fibromyalgia?
Medications prescribed to treat fibromyalgia pain are NSAIDs, antidepressant analgesics, antiepileptic analgesics, muscle relaxants and opioids. Recent study involving 1700 patients published in 2012 by Robinson RL suggest 182 types of medications were prescribed. Majority of patients (77.8%) were treated with more than one medications. Most frequently used medications were duloxetine (26.8%), non-steroidal anti-inflammatory drugs (26.6%), pregabalin (24.5%), opioids (24.2%), tramadol (15.3%), benzodiazepines (15.2%), cyclobenzaprine (12.9%) and milnacipran (8.9%). Symptoms of fibromyalgia are less severe with medications in most cases and pain disappears for prolonged period of time in few young individual, which suggests fibromyalgia is a real pain inducing muscle abnormality.
Where are the Most Common Location of Fibromyalgia Pain?
Fibromyalgia is a widespread musculoskeletal disease. Most common site of muscle pain is neck, back, shoulders, pelvic girdle and hands. Most of the patient always describe the muscular pain over several site, which again indicates the fibromyalgia pain is real.
Is Fibromyalgia Common in Female?
Yes, fibromyalgia symptoms are common among middle age (35 to 55 years old) females.
What are the Symptoms of Fibromyalgia?
Fibromyalgia symptoms are chronic widespread pain localized over muscles, connective tissue, tendon and ligaments. Ligament and tendon close to joints cause referred pain in joints. The description of distribution of pain is often similar in several patients suggesting the disease affects same muscles in all individuals, which often suggests the fibromyalgia pain is real.
Additional Symptoms of Fibromyalgia are as follows:
- Irritable Bowel and Bladder Symptoms
- Restless Legs Syndrome
- Facial Pain
- Impaired Memory and Concentration
- Depression and Anxiety
What is Fibromyalgia and Fibromyalgia Syndrome?
Fibromyalgia is word derived from three words fibro-myo-algesia. Fibromyalgia is a diagnosis of pain, which originates in muscles and fibrous tissue like tendon and ligaments. Fibromyalgia syndrome is the diagnosis of fibromyalgia pain associated with additional symptoms as described above.
How is Fibromyalgia Diagnosed?
Currently, there are no laboratory tests available for diagnosing fibromyalgia syndrome. Diagnosis depends on history and examination. Physical examination will be directed to evaluate spread of musculoskeletal tender points. In the past, the fibromyalgia was diagnosed if patient had minimum 11 tender point of 18 diagnostic tender areas. Eighteen point diagnostic tender areas are debated and not a reliable diagnostic test. Such outcome of examination indicates the fibromyalgia pain is real and should be considered for further research. Study published by Hauser Et al suggest fibromyalgia is a widespread muscle pain associated with additional symptoms.
Is fibromyalgia a Widespread Muscle Disease?
Yes, fibromyalgia is a widespread muscle and connective tissue disease and may be associated with additional symptoms.
Is 18 Trigger Points Test Reliable?
In the past several fibromyalgia patients were rejected for treatment since physicians were unable to locate 18 tender muscle area. The recent studies and experience suggest fibromyalgia causes real pain and leads to debilitating condition. The severe pain caused by muscle disease is a real pain and has interfered with job and normal routine lifestyle of patients affected with fibromyalgia. The recent study suggest 18 trigger point test is not reliable.5
Why Some Medical Care Providers Believe Fibromyalgia Is Not Real?
The drug seeking individuals have tried to pretend to be patient suffering with muscle pain to get the opioids. Primary care physicians often had bad experiences with few drug abusers who were treated for chronic pain illness like fibromyalgia. Some of these patients were caught by law enforcement in drug seeking or addiction behavior.
Patient suffering with widespread muscular disease may give an impression of an individual trying to drive extra attention. Medical care provider who may be seeing few real fibromyalgia patient for over several years of similar symptoms often feel patient is either malingering or drug seeking since patient never feels better. Fibromyalgia is a real pain and patient suffering with muscular pain lasting more than 6 months should be seen and treated by physician trained in pain management, rheumatology/muscular illness or rehab physical medicine.
Is It True, Opioid Misuse and Abuse is Common in Patients Diagnosed with Fibromyalgia?
No, only 1/3rd of patients suffering with fibromyalgia are treated with opioids. Studies have indicated long term opioid use is often associated with opioid dependence and addiction. Drug seekers who get caught while abusing opioid prescription are less often diagnosed as fibromyalgia. Though, few drug seekers do pretend to be fibromyalgia patient to get opioid prescription. Most of the drug seeking patient get caught and that does reflect adversely on fibromyalgia diagnosis. Retrospective Canadian Study published by Rheumatologist Fitzcharles MA Et al in 2011 involving 457 fibromyalgia patients suggest 32% of fibromyalgia patients were treated with opioids.7 Patient suffering with fibromyalgia often suffers through pain several hours a day for several days. When fibromyalgia pain is real, patient often tries all medications including opioids and few may get dependence or addicted to opioids. Though, fibromyalgia pain is real, now patient is questioned for either opioid dependence or addiction. Study also suggest opioids were prescribed to patient population of lower education, unemployment, disability, psychiatric disorder, history of substance abuse and past history of suicidal attempt.
I Have a Widespread Muscular Disease, Am I a Drug Seeker?
No, you are not. Fibromyalgia is a real pain and widespread disease. Physician will establish diagnosis depending on character of pain or presence of 11 tender point. Most of the patients suffering with fibromyalgia have low pain tolerance and low pain threshold. During examination, if real pain of fibromyalgia is provoked by examiner then response is exaggerated. Few physicians, nurse practitioners and physician assistance may have had bad experience with few patients pretending to be having fibromyalgia. Examiner sometimes may feel patient with low pain threshold is acting or malingering to seek opioids. In such cases you should be seen by a physician experienced in treating fibromyalgia like a pain physician or Rheumatologist or PMR (physical medicine rehab) physician.
Are Opioids An Effective Treatment For Fibromyalgia?
Scientific study suggests effectiveness of long term opioid use in chronic non-malignant patient is weak. Opioids causes dependence and addiction when used for long term. The opioid dosage requirement increases with time and patient often develops resistance to pain relief even though fibromyalgia pain is real. In such cases prescription of opioids does not help to relieve fibromyalgia pain, but may aggravate addiction behavior. Opioids is found to cause dependence and addiction in few patients if treated continuously for prolonged period such as 3 to 6 months. Long term opioid treatment causes tolerance and resistance for analgesic effects even in patient suffering with real fibromyalgia pain. Addicted innocent patients and their close relatives have disapproved treatment of opioids for fibromyalgia disease even though pain is real. The disapproval of opioid therapy even though pain is real is because of occurrence of side effects like tolerance to opioids, resistance to therapeutic effect, addiction and dependence. Several complaints were received by various medical organizations from relatives and patients regarding patients were forced to take opioid for chronic pain. Scientific studies and research suggest opioids may not be effective in treating real fibromyalgia pain as long term analgesic.9
What are My Options Since I Have had Several Side Effects to Non-Opioid Medication?
If your pain is real, you may be a candidate for opioid treatment under supervision. You should be treated at Multidisciplinary Pain Clinic or Specialty Pain Clinic. Detailed history, examination and investigation should establish diagnosis of your pain. History of medications and side effects should be documented in details. Pain specialist will prescribe opioids if indicated and closely monitor for any side effects. You should be aware and prepare for side effects like addiction and dependence. If you do eventually show symptoms of either addiction or dependence you may be enrolled into drug rehab program or opioid withdrawal program. The side effects of long term opioid use are terrible and sometimes life threatening.
- Wolfe F, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-172.
- Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis Rheum. 2008;58(1):26-35.
- Harris RE, et al. How do we know that the pain in fibromyalgia is real? Curr Pain Headache Rep. 2006;10(6):403-407.
- Elvin A, et al. Evidence of a novel neuroimmune mechanism in fibromyalgia. J Rheumatol. 2006;33(2):360-371.
- Hauser W, et al. Fibromyalgia syndrome: classification, diagnosis, and treatment. Dtsch Arztebl Int. 2009;106(23):383-391.
- Robinson RL, et al. Frequency and clinical correlates of posttraumatic stress disorder in fibromyalgia patients. Pain Med. 2012;13(10):1472-1478.
- Fitzcharles MA, et al. Management of fibromyalgia syndrome at the primary care level: a consensus report. BMC Musculoskelet Disord. 2013;14:167.
- Thieme K, et al. Pain in fibromyalgia is not limited to single body regions – evidence from widespread pain index and pain extent score. Rheumatol Int. 2011;31(4):445-450.
- Ballantyne JC, et al. Opioid misuse in gastroenterology and non-opioid pharmacological approaches to visceral pain. Am J Gastroenterol Suppl. 2018;2:16-23.
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