Many medical doctors overlook chronic-fatigue syndrome
Chronic-fatigue syndrome, fibromyalgia, chronic pain and pain management continue to be hot topics in the world of medicine. But since most doctors are disease-focused, and pain and fatigue are seen as symptoms, these disorders are often overlooked and misdiagnosed.
Couple that with the fact that the majority of fibromyalgia sufferers are women, and you have another realm of medical disparity with a gender slant.
Because so much information abounds regarding fibromyalgia and chronic fatigue, the next three columns will be devoted to the growing occurrence of these rheumatic disorders.
We’ll begin with fibromyalgia.
Sometimes called fibrositis, fibromyalgia is a condition associated with widespread muscle and soft tissue pain and fatigue. Others symptoms can include muscle stiffness (especially in the morning), sleep disturbances, headaches, irritable bowel syndrome, anxiety and depression, dizziness and jaw pain.
What causes fibromyalgia? Doctors don’t know for sure, but experts at the Mayo Clinic believe it may be due to chemical changes in the brain, sleep disturbances, an injury to the upper spinal region, infection or abnormalities of the autonomic nervous system.
Fibromyalgia affects roughly 2 percent of the American population, with women being seven times more likely to develop it. Most of these women are of childbearing age.
Even though symptoms of fibromyalgia existed previously, it wasn’t until 1990 when the American College of Rheumatology (ACR) gave it a name and guidelines for diagnosis.
But because the disease cannot be determined by what many doctors consider a more scientific approach – mainly laboratory tests – doctors still frequently diagnose it as a psychosomatic or hypochondriacal disorder.
This is perhaps the most frustrating aspect of the illness. Patients know they are sick, they know the pain is real. Yet lab tests generally come back normal.
The ACR states basically two criteria for diagnosing fibromyalgia. The first is a history of widespread pain on both sides of the body, both above and below the waist, for at least three months. The second is pain in a number of tender points located on the body.
The ACR originally said at least 11 of 18 tender point sites must be sensitive to pressure, but some fibromyalgia experts now believe the condition can exist with fewer. Still others question the reliability and validity of these guidelines altogether as a diagnostic tool.
Although fibromyalgia is not a form of arthritis, the Arthritis Foundation recognizes is as an arthritis-related condition, a soft-tissue rheumatism most often known for causing pain and stiffness around the joints and in muscles and bones. The pain generally occurs throughout the body, but may also seem to localize in regions such as the neck and shoulders, or upper back.
The pain is not the same for all sufferers. Some describe it as burning or gnawing, some as aching, some more like soreness. Some patients feel more stiffness than pain. It can be worse at certain times of the day, and change when the weather changes or activity levels change. Most will have fatigue or exhaustion and a significant decrease in their endurance.
Many will have impaired memory. The Arthritis Foundation describes this “fibro fog” as unclear thinking or cognitive dysfunction. Patients become forgetful, forget their words or mix them up or simply lose their train of thought. Treatment for these problems will differ vastly from treatment for pain.
Perhaps the reason many doctors have been skeptical of fibromyalgia as a disease is the prevalence of mood disorders among patients. Changes in mood are a common occurrence, with depression being the most common. Therefore, when patients complain of pain, many doctors are not taking them seriously.
But a recent study should help to dispel that myth. Researchers at the University of Michigan Medical Center in Ann Arbor found that patients with fibromyalgia exhibit pain that is very real but very different than the average person.
The test study measured levels of brain activity while applying pressure to the base of the left thumbnail.
Subjects, who had been diagnosed with fibromyalgia, reported pain at approximately half the level of pressure that caused pain in the healthy control subjects.
After scientists evaluated all the results, they concurred that there is some sort of malfunction in the way the central nervous system of fibromyalgia patients process painful stimuli.
In essence, they have a much lower pain threshold.
That could be a key factor as to why a patient can have severe pain and yet not appear to be injured even to the trained eye.
Most fibromyalgia experts are generally rheumatologists or pain management specialists, but sometimes primary care physicians, internists or nurse practitioners can be just as knowledgeable.
It depends on their areas of interest and how well they stay updated. But finding someone who can accurately diagnose your fibromyalgia can be difficult and frustrating.
And until you’ve ruled out other conditions which these symptoms sometime mimic, you won’t be receiving the best possible treatment and care.
Experts recommend you find a local fibromyalgia support group or contact a national organization for possible physician referrals.
Medications are usually prescribed for the pain of fibromyalgia, with the most common being aspirin, ibuprofen or acetaminophen, certain antidepressants and muscle relaxants.
Sometimes, sleeping aids are prescribed to ensure an undisturbed night of restorative sleep.