MY COMMENTARY
As a specialized pain clinician who has run one of Canada’s first pain clinics for the past 28 years, I have seen hundreds of patients who: a) have been diagnosed as suffering from FM by their rheumatologists or family doctors and
b) represent the hardest to treat cases. I am asked often how do I feel about FM. Here is a summary of my experience over the hundreds and thousands of patients I have seen:
• FM is the end product of a myriad of conditions, characterized by widespread pain. It is not necessary to meet the 11 or more tender point criteria as I have seen many patients who meet these criteria one day and not the next and I have seen patients who do not meet the criteria at all. I certainly agree with the concepts cited in my previous column regarding the tender point/ACR criteria. (Of note, currently committees are working to devise new sets of clinical diagnostic criteria. I can assure you that the “famous tender points” will not be part of these criteria).
• Unfortunately in my experience the term FM has been used too much and too often. It is an easy label to attach to patients who present with diffuse pains. I have seen many patients who had been misdiagnosed as FM when the underlying disorder proves to be later multiple sclerosis, syringomyelia, peripheral neuropathy or rare widespread pain conditions such as polymyalgia rheumatica, “stiff person’s syndrome” etc.
• Given the fact that I run a chronic pain clinic, I am bound to explore equally well physical but also psychological factors and environmental stressors for everybody who comes to our program. In the difficult FM cases that arrive in my door, numerous psychological factors and psychosocial conditions remain undetected and not addressed, while patients come loaded with multiple medications and strong opioids. Conventional medical consultants have paid very little attention to the “whole person perspective” for FM patients, a notion that has only become important recently.
• True FM is indeed a condition where the central nervous system malfunctions in some way and increases the perception of pain or a malfunction of the processes by which naturally pain is harnessed. It can exist on its own or coexist with several other musculoskeletal or neurological syndromes. The history of such patients is very characteristic when one takes the time to dwell in details.
• But is FM an irreversible disorder that will lead necessarily to high levels of disability? Earlier on it was thought to be so. However, I have seen numerous cases where the process is well harnessed and “life goes on” or has even reversed. Does it have to be associated as well with terrible disability? My answer again is No, not all cases will go this way. They are actually many patients with FM who have ongoing generalized discomfort but live productive lives as spouses, companions, parents and working individuals, provided they are aware of limitations and they organize their lives accordingly.
