Fibromyalgia is a disease causing widespread 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 A et al 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.6 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%).
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.
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.
Additional symptoms of Fibromyalgia are as follows:
- Irritable Bowel and Bladder Symptoms
- Restless Leg 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 is depends on history and examination. Physical examination will be directed to evaluate spread of musculoskeletal tender points. In the past 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.5 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?
Recent study suggest 18 trigger point test is not reliable.5
Why Some Medical Care Providers Believe Fibromyalgia Is Not Real?
Primary care physicians often had bad experiences with few patients 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 patients a year of similar symptoms may feel patient is either malingering or drug seeking. 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 patients were treated with opioids.7 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 widespread disease and at the time of examination patient may not have 11 tender point to be diagnosed as fibromyalgia. Most of the patients suffering with fibromyalgia have low pain tolerance and low pain threshold. During examination, if pain is provoked by examiner then response is exaggerated pain. Few physicians, nurse practitioners and physician assistance may have had bad experience with few patients pretending to be 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.
Why Opioid is Considered Not Effective in Treating Fibromyalgia?
Scientific study suggests effectiveness of long term opioid use in chronic non-malignant patient is weak.8 Fibromyalgia is a non-malignant chronic disease and may last for several years. Opioids may cause dependence and addiction in few patients if treated continuously for prolonged period of 3 to 6 months. Long term opioid treatment causes tolerance and resistance to opioid for analgesic effects. Addicted innocent patients and their close relatives have disapproved treatment of opioids for fibromyalgia disease after occurrence of side effects like tolerance to opioids, resistance to therapeutic effect, addiction and dependence. Several complaints were received by various medical organizations regarding patients were forced to take opioid for chronic pain. Scientific studies and research suggest opioids may not be effective in treating fibromyalgia as long term analgesic.9
What are My Options Since I Have had Several Side Effects to Non-Opioid Medication?
You may be a candidate for opioid treatment. 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.
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