FIBROMYALGIA:  INVISIBLE PAIN 

Pain is truly “a four-letter word”®.  Pain can neither be seen, felt, touched, nor measured, and the most reliable description we have of pain is from the patient.

If we think of fibromyalgia, or as we should rethink fibromyalgia, we have to look at fibromyalgia as a newer problem, not necessarily as a disease, but we will call it a syndrome.  A syndrome is a group of problems, not an individual disease.  These groups of problems have unique characteristics, and any one of them might be finding an effective treatment pathway, that helps us unravel the troubling problems caused by fibromyalgia. 

Fibromyalgia is a syndrome.  It is, by its nature as a syndrome, not really a disease as people would know. 

Taming the fibromyalgia dragon requires understanding of the many aspects of an individual’s symptom experience.  Are your symptoms from your stomach, muscle?  Do you have irritable bowel?  Do you have fatigue?  Do you have a substantially interrupted sleep pattern?  Are you unable to do anything that you used to do due to unrelenting widespread pain?  Fibromyalgia is agreed upon as one thing—a disease entity or a painful entity.  In fact, fibromyalgia really is a calamity.  It took years to be recognized.  It was ignored and misunderstood, and there are still doubters who consider this disease a legend more than accepted disease entity.

When we talk about pain, pain is not a traditional disease.  We heal, but do not always cure.  Think of it like diabetes and hypertension. Fibromyalgia can be managed, but it needs to be managed differently than a standard disease.  Remember, it is a syndrome.

The pain is biological, psychological, and social.  It affects all parameters, including even a spiritual or religious component.  We call it biopsychosocial.  We cannot separate these three because the brain will not separate those three.

Fibromyalgia is a disease machine.  It takes its own direction, and many people have their own personal experience. 

Does fibromyalgia really exist?  There is “fibro” history.  Two thousand years cannot be wrong.

“Is there nothing to you all that pass by behold and see is there any pain likened to my pain which is done unto me wherewith the Lord has afflicted me in the day of his fierce anger?

From above, he set fire to my bones…and I am weary and faint all day.”  Lamentations 11:12-13.       

“…[A]nd whereas the nights are appointed to me when I lie down I say ‘When shall I arise and the night be gone’ and am I full of tossing to and fro unto the dawning of the day…and the days of affliction have taken a hold upon me.  My bones are pierced in me in the night season, and my sinews take no rest.” Job 7:3-4, 30:16-17.   

Even letters of Bernard Noble (1833-1896) described what many patients quote today.  “Is it possible that I am more seriously ill than my doctors think.  The pain will not go away…I have been a frozen wretch my whole life, hardly able to stand a whiff of wind or pain.  My rheumatic pains leave me no rest.  I suffer from stomachaches.  My headaches are so terrible that life seems filled with bile…paralyzing fatigue….” 

Sir Maningham (1750) described fibromyalgia as a “little fever,”  

George Miller Beard (1839-1883) “Living on a plane lower than usual, neurasthenia. 

The first rheumatology textbook was in the 1940s by Dr. Hencha ? where he first termed “fibromyalgia”.  In 1990, the American College of Rheumatology adopted criteria.  ACR criteria retired old definitions, eighteen tender trigger points.

The “flawed fibro” concept: Fibromyalgia and myofascial pain syndrome.