I think that fibromyalgia is a diagnosis that is used too freely by both physicians and patients. It is often used when no other etiology for a person's symptoms of fatigue with diffuse aches and pains can be found after a physical exam is performed and laboratory studies are obtained.
The purpose of a diagnosis is several fold. For the doctor, it defines an array of effective treatments and anticipated outcomes. For the patient, it provides reassurance that they have a known, definable condition with predictable long term expectations.
The problem arises for a doctor when a diagnosis is assigned to a patient prematurely or incorrectly. The problem arises for a patient when a diagnosis is misconstrued, resulting in unwarranted feelings of helplessness and hopelessness.
Not so long ago, many patients were given a diagnosis of hypoglycemia or chronic Epstein-Barr virus infection to explain a constellation of vague symptoms that did not appear to have any clear medical explanation. These diagnoses allowed the doctor to have an explanation to the give the patient for their condition and avoid the need for additional studies or referrals. The patient could be told that they just have to live with it as there were no effective treatments.
The diagnosis allowed the patient to be assured that no dire, life-threatening condition existed. Although no treatment would help, a variety of symptoms could now be safely ignored whenever the patient's particular condition flared up.
The diagnosis that serves this function now is fibromyalgia. While there is no confirmatory blood test or x-ray that can establish this condition with certainty, there exists a defined list of symptoms and subjective exam findings to support it. More often than not, the diagnosis is loosely and frequently applied.
My professional opinion is that a patient with this condition has an abnormally low pain threshold. Everybody has aches and pains daily. Most people are either too busy to notice them or they minimize those that they do notice and accept that they occur without allowing them to limit their activities or become the focus of their lives. Oftentimes the fibromyalgia patient will obsess over every minor symptom.
I believe that people with fibromyalgia have true symptoms and real pain. I do not believe that a physician is doing those patients any favors by enabling them to view themselves as disabled or invalids because of the condition. I have seen many patients on disability and on chronic narcotics because of fibromyalgia.
A patient is better served by having a doctor treat the symptoms of this condition with medications that are safe to use long-term such as anti-depressants, sleep-aids, muscle relaxers, and non-addictive pain medications. The doctor needs to encourage the patient to try and live a fully-functional life and not support the patient's erroneous belief that their condition should dominate their day to day existence.
Some patients with fibromyalgia will doctor shop and prescription shop in a futile attempt to become symptom free. The doctor needs to make it very clear to the patient that the above scenario is not realistic. Rather the emphasis should be on safe, long-term symptom control to allow the patient to participate in as much work and recreational activity as is feasible.
If the patient, and especially their doctor, sows a future of misery and limitations, that is what is learned and that is what is reaped. The power of positive (and realistic) thinking is important and genuine.
