According to a Medscape video editorial:In 1990, The American College of Rheumatology established diagnostic criteria for fibromyalgia based on the scoring of 18 potential tender points (pain on palpation with a 4-kg force, pain at 11 of 18 sites is necessary to meet the criteria). "It turns out, however, that these tender points have nothing to do with fibromyalgia. Biopsy of the tender points shows no pathologic changes, and numerous studies have not shown any abnormalities in the musculoskeletal tissues that are painful.
Current evidence points to a neurologic disorder of central pain processing. We will no longer need to refer our fibromyalgia patients to the rheumatologist."
Some doctors doubt if fibromyalgia truly exists but the patient symptoms are real and should be addressed. Duloxetine (Cymbalta) and pregabalin (Lyrica) have been used with some success to treat this disorder. Lyrica is the first and only FDA-approved medication for fibromyalgia therapy.
Dr. Jeffrey Thompson, a physical medicine and rehabilitation specialist at Mayo Clinic discusses fibromyalgia, it's symptoms and some treatment ideas. Fibromyalgia Overview - YouTube http://bit.ly/19m4FxA
References:
Fibromyalgia Is Not a Rheumatologic Disease Anymore. George T. Griffing, MD. The Medscape Journal of Medicine. Webcast Video Editorials.
Pharmacotherapy of Fibromyalgia - Medscape review, 2011.
Treating Fibromyalgia. AFP, 2000.
Fibromyalgia. eMedicine, Aug 15, 2007.
Fibromyalgia: Slideshow. Medscape.
Tai chi may be a useful treatment for fibromyalgia - NEJM, 2010.
Sexual dysfunction is common in patients with fibromyalgia - reported by 87% of females and 76% of males http://goo.gl/EsVTx
Image source: Wikipedia, Gray's Anatomy, public domain.
Image source: Wikipedia, Gray's Anatomy, public domain.
Another cause for severe "fibromyalgia-like syndromes" is vitamin D deficiency. Patients in the very high latitudes, with minimal sun exposure and vitamin D intake can have a similar clinical presentation.
ReplyDeleteWhat is to be measured is the 25OH vitamin D levels. This is the best way to measure body levels of vitamin D. if it is low (less than 30) should be supplemented. For patients with extreme deficiency (less than 20), very high doses of vitamin D2 or D3 ar recommended
(50,000 units per week for 6-8 weeks) and then down to 1,000 daily until levels are replenished.
Many patients report a significant improvement in their symptoms. This is an important cause to be considered which on the other hand may at long term prevent other comorbidities as osteoporosis.
I've come across a fair number of MDs who doubt the existence of FMS. It doesn't change the fact, however, that fibromyalgia patients experience and report significant symptomology.
ReplyDeleteActually vitamin D seems to be popping up in the news for linkage to a wide variety of impairments.