Chapter 1-Pain From Nowhere: Fibromyalgia is A Failure of Medical Science

Who would want a disease or a diagnosis of a disease that has been described for almost two hundred years, that correlates with widespread pain and causes widespread tenderness, is associated with a significantly disrupted sleep pattern, has no identified known causes, has no known treatment, is chronic, and will persist for the rest of one’s life?

Over 6 million Americans diagnosed with fibromyalgia have pain that apparently nobody knows the cause of or how it even develops.  It is noted as far back as 1816.  Fibromyalgia is one of the most prevalent rheumatic diseases encountered.  Fibromyalgia is characterized as a medically unexplained disease.

When patients with chronic widespread pain are examined for tender fibromyalgia points about 1 out of 5 individuals had 11 or more tender points.  The tenderness had little relationship to the pain itself and was better correlated with depression, fatigue, and poor sleep.  The painful tenderness is found in at least 11/18 fibromyalgia points.

The mean patient age, at time of the diagnosis, is forties to fifties.  It is more common in females.

The core symptom of fibromyalgia is chronic widespread pain.  It is mostly located in the soft tissues, especially in muscle areas.  The pain can vary over the course of a day as well as over days and weeks.  The pain is greater than that reported by rheumatoid arthritis patients.

Another problem associated with fibromyalgia is fatigue.  Sleep disruption is a significantly prominent and frequent feature of fibromyalgia.  Patients awake unrefreshed.  Patients show, in EEGs, that there is an intrusion on the stage 3 and 4 Non-Rapid Eye Movement (NREM) deep sleep delta wave pattern.  It is worth noting that the experimental disruption of slow wave, stage 3 and 4 NREM sleep in healthy, normal individuals produces muscle aching, stiffness, and increased tenderness.

Cognitive impairments are also reported by many fibromyalgia patients.  They describe difficulty with short-term memory, concentration, and logical thinking.

Fibromyalgia patients have a greater number of lifetime psychiatric diagnoses compared to controls, especially mood disorders such as depression and anxiety disorders.  Major depression in 20-30% and anxiety disorder in 10-20% at the time of assessment were reported.  Psychiatric disorders including depression, anxiety, stress disorders like post traumatic stress disorder, and sexual and physical abuses are identified in 75% of dysfunctional fibromyalgia patients.

Other symptoms reported by individuals with fibromyalgia includes headaches, restless leg syndrome, irritable bowel syndrome, irritable bladder or female urethral syndrome, cold sensitivity along with cold hands and feet, sensitivity to chemicals, weather medications, loud noises, and bright lights, dry eyes and mouth, dizziness, paresthesia and dysesthesias (needles, pins, numbness, tingling, or unusual skin sensations) without obvious neurologic abnormality, skin photosensitivities, skin rashes and mouth ulcers.

There are no identified laboratory abnormalities that help diagnose, treat, or define prognosis of fibromyalgia.  The role of laboratory investigation in fibromyalgia is to assess for the presence of other conditions that co-exist with fibromyalgia or conditions producing fibromyalgia like syndromes.

Once a diagnosis of fibromyalgia is made, all other and subsequent complaints and findings that cannot be otherwise explained are attributed to fibromyalgia.  Forever.

Patients and doctors are in dire need of something new, different and more effective than the current thinking and treatment related to fibromyalgia.

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