Saturday, May 14, 2011

Family Medicine: Fibromyalgia Flashback , Let's Upgrade for National Fibromyalgia Awareness Day

A patient on my first month of in-patient general medicine in medical school at The Ohio State University had a lot of pain.  Back, neck, arms but somehow mysterious to the attending physician and threatening to the resident and intern.  They treated her with Demerol injections and physical therapy, but sought mostly to get her out of the hospital with her challenging pain.  Fibrositis was the diagnosis, but it didn't satisfy the physicians.  They also didn't know what to do for her further management, since Demerol injections weren't exactly suitable for self administration.  I read about Fibrositis in Degowin and Degowin, the physical diagnosis book that still is my favorite, but the mystery persisted.

I don't remember patients with Fibrositis in residency training in Hershey, PA, but a couple people early in my practice in Granville, OH had something similar with soft tissue pain in the back.  After six or seven years in practice, someone came into my practice with the diagnosis of fibromyalgia.  Her neck, upper back and low back hurt frequently.  She also had fatigue and painful, cystic breasts.  She took Darvocet chronically for the back pain and ate a low caffeine diet and B vitamins for the breast pain.  She developed more and more pain and fatigue, then seemed to disappear for about two years.  At that time, she came to the office for an acute respiratory infection.  I was surprised at how cheerful she was.  I asked how she got to be so cheerful.

"Divorce, I got divorced."  Wow, I thought and asked what led to the divorce.  "He was controlling and abusive.  He said if I ever divorced him, he would kill me.  I finally realized that I was already miserable, maybe even worse than dead, so I divorced him.  I feel great.  I feel alive again."  "So, where is your ex-husband now?"  I asked.  "He moved back near his family about 150 miles away," she replied.

I was impressed that getting freedom could alleviate so many symptoms.  I wondered about the workings of Fibromyalgia.  How can such misery take a vacation?

I read more about soft tissue inflammation over the years and was fortunate enough to co-teach a course in chronic pain to Wright State University Medical Students for six years, over-lapping with six years of teaching a train the trainer workshop to family medicine faculty in the NE states through the Northeast Regional Meeting of the Family Medicine Education Consortium.  We even published a Pain Management monograph through the Society of Teachers of Family Medicine a couple years ago.  I was pleased to be the lead author on the Complementary and Alternative Medicine section while collaborating in other sections.

There is no pain management teaching without teaching about Fibromyalgia.  It has many symptoms and many faces and many seasons.  It seems to happen in those (mostly women) with a genetic predisposition for it who take a huge hit from illness plus life that gets stuck somehow and beats the daylights out of their body and their spirit.  It sometimes goes away after a couple years.  Treatment is multifaceted.  Touch and love are important therapies, while energy therapy seems to be temporarily helpful at regular intervals.  Gabapentin often is a helpful medication.  We don't know yet how best to prevent it.  It still holds mystery, challenge and frustration for both patient and doctor.  It forces the relationship based nature of Family Medicine to rise to therapeutic levels.  It sometimes can't be described.  It is often misunderstood and still doubted by many physicians.  But it is very real and it isn't going away.

I salute the efforts of so many patients with Fibromyalgia to have a life and to be understood.  Today is National Fibromyalgia Day.

Check out these sites for more insights about this disabling disease:

National Fibromyalgia Awareness Day

Fibromyalgia by Meredith Gould

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