Fibromyalgia & Pain Syndromes
Kristine Phillips, MD, PhD, associate professor of medicine at Vanderbilt University Medical Center, Nashville, introduced the topic of fibromyalgia: “Fibromyalgia is not treated by all rheumatologists, and it is still controversial,” she said. “It has not been adopted by any one specialty … . Those of us who think we don’t see fibromyalgia—maybe—we just aren’t recognizing it.”
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By natural extension, if physicians aren’t recognizing fibromyalgia, patients may not be receiving optimal management of their pain symptoms. In many cases, patients with fibromyalgia experience pain even though the stimulus should not cause pain. Although most physicians associate fibromyalgia with this tenderness, sleep quality is also a major component of the disease. Additionally, patients with fibromyalgia are frequently diagnosed with irritable bowel syndrome. Dr. Phillips explained that her growing appreciation of the complexity of the underlying mechanism of disease has extended to the recognition that many fibromyalgia patients have a history of sexual trauma.8
Researchers have identified single-nucleotide polymorphisms associated with abnormal pain sensations in fibromyalgia patients.9 This abnormal pain response appears to be due to an amplification of the pain signals received by the patient, resulting in an altered central sensitization of neurons. Additionally, fibromyalgia patients do not experience the typical reduction in pain upon receiving a second stimulus. This aspect of their distorted pain perception appears to be partially the result of an overlap between the regions of the brain involved in distinguishing pain and affective symptoms.
Next, Dr. Phillips described her approach to managing fibromyalgia patients, explaining that she treats pain in a multi-factorial fashion. She begins by determining which of the patient’s symptoms are related to fibromyalgia and which may be related to something else. For Dr. Phillips, an important part of caring for the patient is helping them understand this distinction. Most fibromyalgia patients respond well to cognitive behavioral therapy and may not require other treatment. Unfortunately, in some regions of the country, especially rural areas, patients may not have access to cognitive behavioral therapy.
Dr. Phillips discourages her patients from seeking disability status. She believes working offers many benefits, especially if the patient finds work personally fulfilling. However, she does complete Family and Medical Leave Act paperwork requesting reasonable accommodations for her patients. She also encourages her patients to maintain an exercise program, even if it’s just going for a walk.
She concluded her presentation by explaining that fibromyalgia consumes a large amount of healthcare dollars and efforts should be made to train an army of nurse practitioners and primary care teams to appropriately diagnose and treat these patients. Healthcare providers should listen carefully to the patient and validate their symptoms, thereby building a good patient-physician relationship. Primary care providers can partner with psychiatrists, who are best suited to manage any concomitant psychiatric illness.