Maybe the doctor you followed some patients with the presumptive diagnosis of fibromyalgia. And maybe after years of following them, and checking for objective signs of disease- lab abnormalities, physical changes, etc. your doctor never found anything to document a medical illness.
But the patients always had the same complaints, always complained of fatigue, not sleeping, muscle aches and not being able to work (I am not saying that this is a description of many patients with fibromyalgia).
So your physician decided that there was nothing to this diagnosis because he/she could find none of the traditional signs of a disease, it responded to no treatments, and there was no progression to a measurable pathological state.
Now there are diagnostic criteria for fibromyalgia. The latest I can find is from the American College of Rheumatology 2010.
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- Widespread pain index score of 7 or more, and a symptom severity score of 5 or more. Or a different mix with lower WPI and higher SS score. So it’s kind of vague.
- Similar symptoms for at least 3 months.
- Other medical conditions that could cause your symptoms have been ruled out.
Previously a “tender point” system was used, but it didn’t work well and the new system was instituted.
Symptoms include, but are not limited to:
- pain or tenderness in muscles, joints, or skin from touch or pressure
- severe fatigue
- sleep difficulties
- memory difficulties
- foggy thinking
So let’s see if we can use these criteria to diagnose people with fibromyalgia.
So do you know of some people who complain about some of these things? I know… let’s see, pretty much everyone I know over the age of 40 has some of these complaints, and more of them the older they are. So these complaints are very common.
Are these complaints associated with other conditions? Poor circulation, obesity, osteoarthritis, rheumatoid arthritis, Lyme disease, AIDS, hypothyroidism, collagen vascular diseases, poor nutrition, sleep apnea syndrome, depression, cancer…etc. etc. So yes, these symptoms are very common in other diseases.
Are these symptoms subjective? Let’s say I have a viral illness and I’m out of work for a week, because I am too fatigued and “achy” to work. You have the same virus, but don’t miss a day. We both fall off our bikes. Our injuries look exactly the same.
You get up, go home, and put ice on it. I wait on the ground for an ambulance to take me to the ER. I miss working the next day. You show up. Did I “hurt” more than you did? So yes, all of these criteria are “subjective”. If you do the point tenderness test on me and every place you touch I say that pain is a “9”, is that real? How can you tell?
There is a blood test being evaluated for Fibromyalgia, the FM/a test. This tests for elevated cytokine levels in your blood. However, elevated cytokine levels can be found in everything from Autism to Zoster. They can be found in high levels in depressed and suicidal patients.
Any inflammatory disorder that activates the immune system will increase cytokine levels. If all other pathological conditions have been ruled out (could take years and 10s of thousands of dollars worth of tests) and this test shows that your cytokine levels are elevated, then your doctor can say you have an occult inflammatory condition in your body, Maybe it’s fibromyalgia. Maybe it’s a disease that will show up later.
I hope you can see why some doctors are skeptical of the diagnosis of fibromyalgia. Because the doctor can’t diagnose it. Only the patient can. And that can sometimes be misleading.
Disclaimer: This is not medical advice. This is a personal opinion based on the situation of a close one.
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