Just two years ago, an article in the New York Times reported that many physicians consider FMS to be a psychosomatic condition, or something that had no identifying medical cause other than simply being in “someone’s head.” Prejudice and discrimination really don’t have a place in a doctor’s office. Neither do vague and opinionated terms such as “medically unexplained syndromes” or “functional somatic disorders.”
Fibromyalgia isn’t alone. At one time rheumatoid arthritis, the psychiatric disorder schizophrenia, asthma, hypertension and hyperthyroidism were all considered psychosomatic. There are doctors still practicing medicine who went through medical school being taught that stomach ulcers were psychosomatic. The discovery of the bacteria called Helicobacter pylori that was found to be cause of most stomach ulcers and the $100 billion dollar market on antacid drugs rapidly changed that idea.
FMS was originally considered purely a disease for rheumatologists because of the presence of body pain and tenderness in the soft tissues. As the scientific progress has advanced, rheumatologists have still maintained primary management of FMS. However, the recent scientific findings have changed things considerably.
Patients with FMS are now being increasingly treated by pain physicians. A 2009 editorial in the Journal of Rheumatology, the premier journal for Rheumatologists was entitled, “Should Rheumatologists Retain Ownership of Fibromyalgia?” The editorial made the statement that
“fibromyalgia can no longer be categorized as a rheumatic disease process, but rather is a pain syndrome centered in the nervous system.”
Who treats pain syndromes? Pain physicians – doctors trained in pain management.
Why the sudden shift when many people in the medical community are still gradually accepting FMS as a true illness? Part of it may be tied to the fact that many people in the medical community are also still having a difficult time accepting how to treat pain. Treating pain is a specialty in medicine just as is rheumatology, internal medicine, or general surgery and requires someone specifically trained who understands the different types of pain and the ways to treat each type. Just as a surgeon understands each different type of operative procedure used for different problems. The surgery to repair a hernia is different than the surgery to remove an appendix.
What makes a pain physician especially capable of treating FMS has been evidence that has been found over the past ten to fifteen years from studies that have been able to look closely at how the nervous system processes and responds to pain. The idea that pain can’t be present if you can’t measure anything clinically is only true providing you’re looking in the right place with your measuring instrument. The last decade has seen advances in these measuring instruments that have finally allowed researchers to see the difference between the nervous systems of people with FMS and those without FMS.
There will be many more articles on this web site that describe what has happened to the nervous system of someone who has FMS simply because the changes are so complex they cannot be described in one article. In short, someone with FMS has a nervous system that has drastically changed – it is not processing pain, and many times, not processing other things as well, in a way that is normal compared to someone without FMS. That is the reason that the editorial in the Journal of Rheumatology made the statement above. For over a hundred years physicians and scientists have been searching for the causes of FMS and it has only been recently that the origins and mechanisms of the pain that patients with FMS feel has been narrowed down to deep with the central nervous system structures of the brain and spinal cord.
The future articles on this web site will discuss what has changed in the brain, how those changes were found, and how newer medications and pain management techniques and treatments can be provided to once again make life comfortable for patients suffering from FMS. We’ll look at each of the symptoms in detail and what can be done for each, talk about the different ways that FMS could have been caused including the effects of both genetics and environment, describe the latest findings using machinery called functional magnetic resonance imaging that can look into nerve cells and provide amazing insight as to how the brains of FMS are different than someone without the disease, and then provide a full and comprehensive review of treatments – medications, therapies, and most importantly treatment that a pain management clinic provides that cannot be found elsewhere.
Keep checking back for more reading.
