Chicago—In the current moment, rheumatologists can be forgiven for focusing on CART cells, bispecific antibodies and other dazzling new technologies that have brought with them a wave of excitement. But in the hustle and bustle of looking to the future, conditions like fibromyalgia have received even less attention than was previously the case (and indeed, this was already an issue for patients with the disease). In the ACR Convergence 2025 session titled, Ouch! What’s New in Pain?, two speakers shed a great deal of light on this important topic.
No Magic Bullet
The first speaker was Michael Kaplan, MD, an assistant professor of Medicine in the Division of Rheumatology at the Icahn School of Medicine at Mount Sinai, N.Y., who studies and cares for patients with fibromyalgia. Dr. Kaplan provided the historical context that explains why treating the condition can prove so challenging for doctors and patients alike.
With the emergence of germ theory in the mid-19th century, medical doctors were able to successfully identify the discrete pathogens that cause infections such as anthrax, tuberculosis and syphilis. The concept of a “magic bullet” treatment—the term created by the German scientist Paul Ehrlich in 1907 to describe the idea of killing specific microbes that cause disease without harming the body itself—took hold and seemed to accurately reflect a reality in which illness could be objectively identified and summarily dealt with. Although these developments were undoubtedly beneficial to society—as indicated by improved life expectancy over the past century—it created a paradigm that applies well to certain diseases but not others.
When a patient with fibromyalgia goes to see a physician, they arrive with expectations that cannot be easily met even in the year 2025. They assume Western medicine has a magic bullet treatment to offer them, and that their doctor will have the time and patience to address the impact that pain has had on their life. But because there is no single, revolutionary pharmacologic intervention for fibromyalgia, and because of the systemic issues related to healthcare delivery and medical education (i.e., high patient volumes and inadequate training in chronic pain management), the doctor-patient interaction is doomed to fail from the start.
Recognizing this situation exists and pre-emptively addressing it, Dr. Kaplan explained, is therefore key to helping these patients. Dr. Kaplan noted he often shows patients a graphic illustrating how fibromyalgia so often co-occurs with other COPCs (chronic overlapping pain conditions) such as migraines, interstitial cystitis, irritable bowel syndrome (IBS), endometriosis and chronic fatigue syndrome. He explains to them the concept of nociplastic pain, which is defined as pain that occurs when the nervous system is overly sensitive or processes pain signals abnormally, even when there is no clear injury or nerve damage. Dr. Kaplan will often tell patients, “If you came to me with an infection, I would prescribe antibiotics, and if you came to me with a rheumatoid arthritis flare, I would prescribe steroids. But fibromyalgia is different and we have to address it differently.” By being clear and compassionate in making these statements, Dr. Kaplan believes rheumatologists and patients can more easily get onto the same page.
