Fibromyalgia is a frequently disabling syndrome characterized by widespread pain, typically with specific tender spots and fatigue. It is closely linked to chronic fatigue syndrome. The entity was first recognized by the AMA in 1987 and defined by the College of Rheumatology in 1990. Doctors generally know little about it and care little about it. Some doctors remain skeptical that it exists or call it a garbage can diagnosis. This is a sad state of affairs.
Patients suffering of fibro are frequently incapacitated and disabled. Many are isolated. Naturally they are depressed. Very depressed. Love ones don't understand and may suffer with care giver burn out.
Some patients go to pain management clinics and were treated with opioids which provide some relief. Most pain docs only know pills and infection therapy. They don't really understand fibro. Those same patients now find pain doctors are no longer to prescribe opioids at the higher doses and detoxing them; this may be a scary time.
Other doctors only know to prescribe Cymbalta and Lyrica which may and may not help. Side effects may be intolerable.
I have had good results treating fibro patients. I got into fibro as a doctor treating Lyme disease. It turns out that a lot of Lyme patients have patients identical to those of fibro patients. I see fibro as a syndrome caused by something else. Treating that something else may be very helpful. Fibro is not a disease per se. It is not an ending point but rather a starting point: what else is going on?
Frequent considerations include: chronic infection, sleep disorders, management of fatigue, understanding mechanism (central sensitization, pain magnification, others), thorough understanding of pharmacology, understanding drug synergism and the use of cocktail therapy for pain and more.
Other syndromes interface with fibro: hypermobile joints and EDS, POTS (postural orthostatic tachycardia syndrome and dysautonomia) mast cell activation syndrome and others.
Doctor recommendations of CBT (cognitive behavioral therapy) and exercise programs are not without merit but most patients are not well enough to benefit from the programs.
Newer pain therapies have been developed, including IV ketamine. A service I do not provide.
Lyme disease is frequently an issue. Many fibro patients with Lyme will never be cured with antibiotics. Fibro needs to be addressed as a separate issue. Other infections may be present, some easier to treat than others.
There is much I don't know. Many pieces of the puzzle are missing. Still most of my patients do well and many get their lives back. Please read my BLOG Lymemd.blogspot.com. There is a lot of overlap.
There is no magic pill or magic pill. Most of my patients get better, although it may take some time. What works for one patient will not work for another. Fibro patients are a diverse group and all need to be evaluated and treated individually. I spend a lot of time with patients, teasing out the specific issues impacting each patient. Fibro is a complex syndrome with many facets. If a particular treatment fails there is almost always an alternative.
I am happy to see fibro patients in my office in Rockville MD.
301 518 7111
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