The Fibromyalgia Controversy

Written By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II Date: July 1st, 2009. Topic: Member Blogs.

I often get calls or emails from people who have been diagnosed with Fibromyalgia and are very confused and frustrated. The frustration comes from some medical providers not believing that the diagnosis of Fibromyalgia is a real condition. Earlier this year I ran across an article New Approaches to Treating Fibromyalgia by Katherine Hobson - U.S. NEWS AND WORLD REPORT – Updated: 01/22/08. To go to this article please go to http://www.buffalonews.com/185/story/257658.html. I’m posting excerpts from this article below to highlight Ms. Hobon’s insightful perspective.

Sufferers of fibromyalgia experience a suite of symptoms: chronic pain throughout the body, sleep problems and fatigue. In some, this syndrome starts with no warning; others get it after a traumatic physical injury, a viral infection, or stressful life event. Symptoms can come and go.

For years, doctors thought the problem must be at the tissues or nerve endings — that is, at the places where it hurt. When they couldn’t find hallmarks of injury such as inflammation or nerve damage, many threw up their hands and chalked up symptoms to depression, anxiety, or that all purpose grab bag for female complaints: hysteria. Over the past decade or so, doctors have come to understand that fibromyalgia is actually a problem of the central nervous system — the brain and the spinal cord — not the peripheral nerves that branch into organs, limbs and skin.

More recently, researchers using functional MRI scans have found that people with fibromyalgia have increased activity in areas of the brain dealing with where and how much it hurts. In other words, far from being whiners, they are wired to be exquisitely sensitive to pain.

What also happens for many people suffering with this condition is they are prescribed opiates by well meaning doctors who want to help. Unfortunately, due to the type of pain they are experiencing opiates don’t really address the real problem. In fact most of the pain symptoms with this condition are neuropathic or burning type pain. One of my patients described it like a lava flow going through different parts of her body. I was very happy that in June of 2007 the FDA approved Lyrica for treatment of Fibromyalgia. Several of my medical colleagues had been using it off label before but most insurance companies wouldn’t cover it and now many of them will.

Then in June of 2008 the Food and Drug Administration (FDA) approved duloxetine HCl delayed-release capsules (Cymbalta) for the management of fibromyalgia. Previously, only pregabalin (Lyrica; Pfizer, Inc) was approved to treat this painful condition. Some see this as a major victory in validating fibromyalgia as a legitimate diagnosis while others see this as a greed-driven pharmaceutical ploy. Having worked with many patients who were diagnosed and living with the pain and problems of fibromyalgia I’m firmly in the first camp.

Some basic tips for managing Fibromyalgia:

● Aerobic exercise, such as swimming and walking, improves muscle fitness and reduces muscle pain and tenderness.
● Heat and massage may also give short-term relief.
● Antidepressant medications may help elevate mood, improve quality of sleep, and relax muscles.
● Patients with fibromyalgia may benefit from a combination of exercise, medication, physical therapy, and relaxation.

To learn more about Fibromyalgia please go to our News and Research 2008 Archive to read my report Cymbalta Approved for Fibromyalgia and New Fibromyalgia Research.

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