Fibromyalgia 10 Years Later: Medical Community Still Puzzled
Nov. 16, 1999 (Cleveland) - For fibromyalgia sufferers who think their
condition doesn?t receive adequate attention from the medical community, a new
report only fuels the fire. The diagnosis and treatment of fibromyalgia -- and
even whether it exists at all -- continue to generate controversy among
physicians, according to Don L. Goldenberg, MD, author of an article on
fibromyalgia that appears in a recent issue of the Archives of Internal
"[Fibromyalgia] continues to be very controversial and causes a lot of
frustration, both in the medical community and for the millions of people who
have it," Goldenberg writes. The problem is that some physicians still
haven?t accepted the existence of the syndrome because of the lack of
"objective, scientific findings," says Goldenberg, chief of
rheumatology at Newton-Wellesley Hospital and a professor at Tufts University
School of Medicine in Boston. "Sometimes we don't pay much attention to
something without scientific or laboratory evidence, and can believe it's all
in people's heads."
It is estimated that fibromyalgia -- which causes pain and stiffness in soft
tissue such as muscles, tendons, and ligaments -- affects about 2% of the
general population. It is more common in women than in men and occurs with more
frequency as people age
Fibromyalgia is especially difficult to diagnose because its symptoms are
mostly subjective, which means that the discomfort sufferers experience can?t
be "visibly" measured. In addition to pain, some persons with the
syndrome also suffer from sleep disturbances, headaches, and fatigue.
Physicians usually make a diagnosis of fibromyalgia based on 1) the number of
places on the body where a patient experiences tenderness (soreness to the
touch) and 2) the pattern of the pain. But a routine physical examination
usually uncovers no other abnormalities.
Traditionally, Goldenberg tells WebMD, both physicians and the general
population have trouble relating to any physical disease that cannot be
objectively and scientifically measured. He compares the syndrome with other
puzzling conditions such as migraine headaches, chronic fatigue syndrome (which
fibromyalgia strongly resembles), and irritable bowel syndrome.
Even if fibromyalgia can?t be measured, Goldenberg says, it is "a common
condition . . . and people are suffering as a result. These [conditions] all
legitimately require further investigation and study.
"There is too much emphasis on looking at these syndromes as being
distinct entities [diseases], and that's where I think some physicians and
patients fall into the trap of saying that something like chronic fatigue
syndrome or irritable bowel syndrome are specific conditions. I think it's more
important to look at all of these disorders as 'mind-body' functional illnesses
that have much more common threads," Goldenberg tells WebMD.
In the decade since fibromyalgia was identified, numerous treatment options
have been studied. In clinical trials, several types of treatment -- including
central nervous system medications, cardiovascular fitness training, regional
sympathetic (nerve) block, biofeedback, hypnotherapy, and acupuncture -- have
been effective. Some patients have benefited from taking antidepressants, but
these drugs? beneficial effects appear to decrease over time, Goldenberg notes.
Behavior modification and stress reduction programs also have been shown to be