Fibromyalgia: Is That All There Is?

"The Three Graces" illustration that appeared in the original fibromyalgia criteria study (1990) with tender points superimposed.

I've been asked (more than once) if there is a blood test that will determine if one has fibromyalgia (also known as Fibromyalgia Syndrome (FMS), nasty and degrading little term that's used, "syndrome," no?)  The short (and sad) news is that no, there is no blood tests that will identify fibromyalgia.  However...

...there are certain blood tests that should be run for three reasons: first, to exclude any conditions that may mimic fibromyalgia; second, to exclude if comorbidities exist - that is, to see if other conditions in addition to the fibromyalgia exist; and third, to factor in what would help establish how and if fibromyalgia symptoms can be lessened.

Before we get into the above reasons, I would like to emphasize that in most cases fibromyalgia is relatively easily established by a rheumatolgist or pain specialist knowledgeable in fibromyalgia.  Not all rheumatologists, pain specialists, or even neurologists, however, are equal in identifying fibro and indeed some of the specialists out there who claim to be well-acquainted with fibro are indeed not specialists in the field.  Unfortunately, I know this first-hand as a "professional patient."  (Ha! But sadly also true.)

But getting to my list:

• Fibromyalgia can occur on its own, yes.  For the most part, however, it's a sign that there is something else going on and that cause needs to be checked out. 

• As they say in the medical field, your usual doc starts looking for horses before the "zebras bit" but when it comes to fibro, a medical history is absolutely necessary as it may point out what would normally be viewed as zebras in most any other medical field.  In other words, it's incredible that when it comes to fibro the zebras are actually horses.  For example, adult growth hormone deficiency is often seen in fibromyalgia as Dr. Robert Bennett first described in 1992.   Car accidents can also be a cause of fibro, although often showing up years later. As is seen in my case, HGH insufficiency and numerous other factors have contributed to my fibromyalgia, including my CFIDS/CFS/ME.  However, lupus, osteoarthritis and even cancer - indeed almost any autoimmune disease and infectious disease - can cause fibro, as well as sleep disturbances (the latter described by Moldovsky and Smythe, 1974).

• There are other blood tests that can (and should) be run to see if it's a nutritional problem. A deficiency in magnesium (Red Blood Cell test should be run or the results will be inaccurate) and Vitamin B deficiencies are just two nutrients that can lead to problems with fibromyalgia. I was shocked, for example, to discover by two different doctors that I was indeed vitamin B deficient (trusting soul that I am NOT) and that it can take up to two years to overcome a vitamin B deficiency. 

I've found that after identifying and treating my many deficiencies, my fibromyalgia got much better, but it took a long time (well over two years for the HGH to also kick in) but I need to be monitored all the time because as I've said so often before, things just keep going wrong.

The American College of Rheumatology has published criteria to help the doctor make the diagnosis of fibro.  However, keep in mind that fibromyalgia is not a diagnosis of exclusion.  It used to be thought of as a "wastebasket" diagnosis, but no more! 

It also used to be thought of as a manifestation of depression. That notion has been disproved by many studies showing that depressed patients perform very differently on neuropsychological testing compared to fibromyalgia patients. The two profiles are simply very different.

Your doctor can use the published fibromyalgia criteria to establish whether or not you have fibromyalgia but blood testing can be very useful in the assessment and treatment of fibromyalgia patients.  However, looking into the various criteria (i.e., the evolution of the criteria over the years) and knowing some of the people involved, I must say that I do have a problem with some of the doctors who are in ivory towers and see few patients, who don't take good histories, as well as those who are afraid to touch their patients.  

But then I'm a bit picky, aren't I?

As always, I hope all are doing the best they can be, only better.  Ciao and paka!

Raphael's original "The Three Graces" with the tender points superimposed.

The (Woman) Doctor Behind President Kennedy's Pain Management

I'm happy to say that there were two articles just published in a medical journal about one of my heroes, Dr. Janet Travell, a pioneering doctor in pain (to say the least).  The articles, which discuss the autoimmune disease and the pain medicine aspects of President Kennedy's care by Dr. Travell, is found in this month's edition of the medical journal Practical Pain Management (with his image on the cover) and can be found at the link here and here.  I am especially excited as Dr. Travell has long been one of my heros - and I just wrote a post about her recently).

Dr. Janet Travell with  First Lady "Lady Bird" Johnson. Dr. Travell became President Johnson's White House Physician after the Kennedy assination. 

I'd like to point out that my "source" who knew Dr. Travell very well was not one of the doctors who wrote the articles - I don't want to mislead you - AND petty person that I am, I'd like you to know that I have excellent sources (ha! regarding "petty," true about "petty" and "excellent sources").  

There are a few problems I have with a few "facts" in the articles, but overall, the information is excellent.  Because of my extensive comments and my real effort to shorten my posts, I'll need to divide my observations into several parts.  I'm afraid that when it comes to pain management I get just a TAD (over) serious!  (Ahem!)

My reservations are mostly small, though some are important, while others are small, period.  On the other hand, there are a few points that I REALLY agree with that I'd also like to point out as excellent points made.  Today I'm starting with Dr. Jay's article in light of trying to spare people long-winded posts. (Yes, yes, I basically said that already!  Sigh!)

1. In the article by Dr. Jay, he's a bit inaccurate and I wonder how well he knew Dr. Travell when he wrote that "Her use of procaine injections was most likely into myofascial trigger points...."   UH...excuse me, but Dr. Travell wrote two volumes about myofacial trigger points, still sold at Amazon, as I noted in my post and I even placed a picture of the volumes at the end of the post.   My source tells me that she most certainly DID inject JFK's trigger points and that was also the consensus at a medical conference where she was the guest of honor.  This was when and where my source first met her as a relatively young man when she approached him in her wheelchair, knowing already who HE was, and saying she was following his career, "young man!"   (He would definitely have been too intimidated to approach her and this man is NOT easily intimidated!  Hero worship can do strange things to people (ha!).)

2. I only hope that when Dr. Jay wrote "other stimulants ... There continues to be methylphenidate for use, as well as amantadine" that this was a spelling mistake (maybe generated by the dictatorial iPad which haunts me as well!) and simply not caught by the editors.  On the other hand, I don't want readers confused by seeing this medicine quoted in this usage.  I only caught this error regarding Amantadine since Amantadine is an antiviral medication which I DO take, but for my CFIDS/CFS/ME, not for my fibromyalgia and/or myofascial pain.  The author most likely meant the stimulant, "amphetamine."

3. Dr. Jay also wrote,  "Finally, and most impressively, Dr. Travell treated more than the symptoms of pain and hormonal dysfunction.  .... Dr. Travell knew then what we know now -- physical exercise is necessary to maintain a number of physiological functions as well as to help decrease pain." 

Now this, the exercise, is a real bugaboo of mine, I fully admit it.  With all due respect, however, I beg to differ and one fibro source has even testified in court many times that exercise is not always appropriate for pain.  It all depends on the patient.   As I keep saying over and over again, we can't be plugged into any formulas!  Dr. Travell most definitely believed in what is right for each individual patient and didn't believe in any set "theory" other than going by results - and this in fact was an example of her genius! Furthermore, as I'm always saying, I've seen more theories come and go over the years, each time doctors absolutely sure that THAT was the answer.  I have finally started looking at everything as what works for me - after much damage was done to me, completely innocently, I must add, and much of it permanent damage - and I've had to long ago stop going with anyone's "dictates."  I can just imagine Dr. Travell looking down and shaking her head at some of the rigidity going on.

4. I whole-heartedly agree with the following excellent conclusion, however, and want to point it out: 

"Bottom line -- Dr. Travell treated President Kennedy in a highly appropriate fashion, using tools that most physicians today wouldn't know how to use, and even in ways they may not have been able to fathom.  I do believe that Dr. Travell knew or intuited various things about drugs and hormones that we now understand better and more deeply.  The fact that her treatment plan was so effective is a function of her exceptional skill as a physician at a time when physicians knew far less than we know now."

Now THAT quote is absolutely right!  Dr. Travell understood one could not be rigid in his/her thinking.  She also understood how much each patient varies and how each patient is unique.  In addition to her care, love and intuition of patient care, she understood that no two patients are exactly the same and each patient's care is unique to that care, something the vast majority of specialists today should remember.

"This is not cookie cutter...you gotta do it right," to quote MY source.

As always, particularly today, I hope everyone is doing their best, only better. As they say, "to be continued!"  Ciao and paka!

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