Fibromyalgia: Wastebasket Diagnosis or Just Garbage?
There is a sham going on in American medicine and no one wants to talk about it. Fibromyalgia is the most common cause of generalized, musculoskeletal pain in women between ages of 20 and 55 years. There is no tissue diagnosis. No radiologic findings. No typical histology.
(PRWEB) August 11, 2005 -- There is a sham going on in American medicine and
no one wants to talk about it.
A patient walks into an office and
complains of diffuse muscle pains of nonspecific nature in several different
skeletal regions. No trauma was sustained. No bruising is present. The patient
is not febrile and cannot distinguish whether the pain feels like it arises from
the joint or the muscles themselves. Not unlikely, the patient also comments on
their persistent fatigue and other nonspecific symptoms like abdominal cramping,
on and off visual disturbances, dizziness, etc.
In his or her head, the
doctor is thinking: somatizer. But in this day and age of malpractice and
better-be-safe-than-sorry medicine, a full work-up is initiated -- sadly. Films
are shot, labs are drawn, history and physical is repeated. Lo and behold, all
is negative. Even the sed rate, (miraculously).
So what do we do as
physicians? We reassure the patient that this is not a physical malady and
suggest that this might be something stemming from their psyche, right? Wrong.
We make up a diagnosis so we have something to label it and thus, something to
treat. Now, suddenly there are mavens of this fictional disease. There are
conferences dedicated to it; text books authored about it; medications designed
for it; TV and radio commercials exploiting it.
Not me.
I won’t
be a part of it any more. It's out of hand, and a recent study is helping
delineate this point. Fibromyalgia is the most common cause of generalized,
musculoskeletal pain in women between ages of 20 and 55 years; in the United
States, the prevalence is approximately 2 percent and increases with age. The
cardinal manifestation of fibromyalgia is diffuse musculoskeletal pain. Plus, a
variety of poorly understood pain symptoms, including abdominal and chest wall
pain and symptoms suggestive of irritable bowel syndrome, pelvic pain and
bladder symptoms of frequency and urgency suggestive of the female urethral
syndrome or of interstitial cystitis.
Fatigue is present in more than 90
percent of cases and is occasionally the chief complaint. There is no tissue
diagnosis. No radiologic findings. No typical histology. How, then, can this be
classified as a physical illness? I was taught way back in medical school that
if it smells like a duck, and walks like a duck, it's probably a duck. Well,
I'll tell you what this smells like…
A recent study, reported by the
Associated Press, is shedding some light on the true nature of fibromyalgia. The
study looked at "real" acupuncture verses improperly applied acupuncture
(accu-placebo) in patients with fibromyalgia.
Now, it wasn't surprising
to us that real acupuncture failed to show benefit versus fake acupuncture. And
this fact did not lend credence to our theory of fibromyalgia as a fictional
disease. Rather, it was that all patients, in both arms of the study showed
dramatic improvement in just one or two sessions, a much shorter treatment
course than expected.
Whether the treatment used was real or fake made
no difference in the study participants. Their symptoms improved greatly just
after one or two sessions suggesting that just enrolling in the study may have
been the best treatment course. Or, perhaps, the attention that was given to
their "disease" improved symptoms.
Adam Burke, an acupuncturist who
treats patients with fibromyalgia and was not connected with the study, said the
findings were not conclusive, nor was the treatment the study's subjects
received consistent with real-life alternative therapies for the condition.
Typically, such treatment can consist of more than a year of
acupuncture, along with complementary therapies like herbs and lifestyle
changes, he said. Also, acupuncture involving electrical stimulation that has
been effective for fibromyalgia wasn't looked at in the study, said Burke, an
assistant professor of health education at San Francisco State
University.
Of course, they should be treated for more than a year. I'm
sure Mr.Burke lets them know that right from the start of treatment.
Are
we too cynical? Possibly. But you show me a patient with no physical exam
findings, no radiologic abnormalities, no tissue diagnoses, and no gold standard
of diagnosis, and I'll show you a patient that has an excellent physical
prognosis.
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Source : http://www.prweb.com/releases/2005/8/prweb271305.htm