Not all Rheumatologists (especially if they had been trained some years earlier and belong to the older generation) believe in Fibromyalgia.
Even if they “believe”, not all are comfortable with managing patients with Fibromyalgia for diverse reasons. One very common reason (which doctors only admit to other doctors) is that Fibromyalgia patients are generally difficult (I sympathize with those patients) as they are generally mistrustful of doctors in general after all their bad experiences with doctors.
Ask two questions of your Rheumatologists.
- a) Whether they believe in Fibromyalgia
- b) Whether they are comfortable and happy treating patients with Fibromyalgia.
If the answer to either of these questions is a No, ask politely for suggestions for a Rheumatologist who is interested in managing these patients. You would be surprised that there are many. Fibromyalgia is a test of a Rheumatologists utmost all-around skills.
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The first order of business is confirmation of Fibromyalgia which is completely clinical. (It involves bedside tests and interviews. There are two criteria for diagnosis both of which are valid. Remember that a diagnosis of fibromyalgia does not exclude any other diagnosis.
Therefore the second order of business is to look for and exclude any other disease that may co-exist or may have triggered fibromyalgia by increasing the risk. The more recent your fibromyalgia, the more the need to look for other associated conditions.
If you find something else along with fibromyalgia, the doctor’s job gets easier. (If you have the disease for 10–15 years, there would be little doubt and the doctor may be able to make a diagnosis just by talking to you)
Managing patients with fibromyalgia is multi-dimensional. Patient education is key so as the patient gets reassured that fibromyalgia is a non-life or limb-threatening benign disease of just pure pain and suffering. So it is important for the patient not to let the disease get to them and fight it valiantly and refuse to be impacted in everyday life. The doctor is there to help you do that.
The treatment would involve drugs that alleviate the different symptoms as well as lifestyle changes. Exercise and good sleep are the cornerstones of Fibromyalgia management. For those who find exercise painful, it is important to have a structured regimen where you start slow and slowly increase the level of exercise.
Improved sleep either with lifestyle changes or with fibromyalgia medicines would have a direct and immediate impact on your pain and other symptoms. Reducing weight is important for those who are obese, as they are in general less likely to respond to drugs (contrary is also true, those who are lean tend to respond better to drugs).
I have seen patients who did not respond to any drugs getting cured simply with exercise and weight loss. While there are several drugs for fibromyalgia that are approved (pregabalin, duloxetine) or off-label, the choice of the first drug should be determined by the specific circumstances of the patient including co–morbidities and is not going to be covered here.
Suffice it to say that different individuals respond differently to different drugs and it is important to find which drugs or combinations thereof work best for any given patient. Therefore, the patient should have patience and stick with your chosen rheumatologist and give him enough time to optimize your management.
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