Thanks for your kind responses to the FMS piece from last week. I kind of suspected I had some FMS sufferers as readers- but I really didn’t know how many.
In this part of the post, I would like to review what Fibromyalgia Syndrome (FMS) is, and almost more importantly, what it is not.
I posted a video on this topic a while ago- and since that time, for reasons I cannot explain, the number of patients with FMS in my own practice has more than tripled. This post will be a little different, as I would really like to focus on eliminating the notion that somehow FMS is a psychological condition.
FMS is what is known as a diagnosis of exclusion, meaning, there are no diagnostic tests or radiologic studies that can confirm the diagnosis, rather, after you haver ruled everything else out you can then start considering FMS as the likely diagnosis.
Some of the conditions which can (depending upon the stage of the illness) symptomatically be similar to FMS: Lupus (SLE), scleroderma, Lyme disease, MS, chronic fatigue syndrome (CFS), rheumatoid disease, and depression. There are others, but these are some of the most common. The thing with each of these diagnoses is that with the exception of CFS and depression, there are clear diagnostic studies that can be done to confirm or reject the diagnosis. Depression is reasonably well understood, and the diagnosis is not that difficult to make in most instances. The interesting thing about CFS and depression is that they often accompany fibromyalgia.
Once you have ruled those things out, you can begin to consider FMS as a diagnosis. Now, there are certain criteria which you look for all of which should be exhibited to confirm FMS as your diagnosis:
-There are 17 classic trigger points (tender point which trigger pain in a different location than the one being touched) which are commonly associated with FMS. A patient should demonstrate 11 of these 17 points, and not necessarily all at the same time.
-FMS is non-articular, meaning it does not directly affect the joints.
-Patient has fatigue levels which do not change appreciably, regardless of the amount of sleep/rest they get.
-There is a somewhat higher incidence of depression in fibromyalgic patients or ‘fibromites’ than in the general population.
This last point is what directs many in the medical community to continue to hold on to the notion that FMS is a psychological issue rather than a physical one. As someone who has had two periods of time in his life addled by extreme pain, I can tell you this- I defy anyone in pain 24 hours a day, 7 days a week to not be depressed. In 1992, the World Health Organization met in Copenhagen, and produced what became known as the Copenhagen Declaration. In this document, the WHO asked the medical community at large to stop writing off FMS as a psychological condition and start treating it as a physiological one.
That was 1992. Why are so many physicians still so reluctant to accept this?
Wednesday, I will review some of the treatment options available for FMS.
Thanks for stopping by!
-Andy
The lovely Chateau Frontenac, Quebec City, Canada.
