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Dr. Clauw's Grand Rounds Update on Fibromyalgia Science & Theory

  [ 1062 votes ]   [ 2 Comments ]
By Editor • • April 16, 2007

Dr. Daniel J. Clauw, MD, has written an update for physicians on the evolving study of Fibromyalgia’s nature and treatment - in language that patients as well as their healthcare providers can understand. Dr. Clauw, director of the Chronic Pain and Fatigue Research Center at the University of Michigan in Ann Arbor, is one of the world's most active Fibromyalgia specialists and researchers.

His article, "Fibromyalgia: Update on Mechanisms and Management," cites more than 30 published studies. It began as an educational ‘Grand Rounds’ presentation for fellows in Rheumatology at Chicago's Rush University Medical Center, and was subsequently published in the April 2007 issue of the Journal of Clinical Rheumatology.

Full Text and Reprints Available

The journal’s abstract of the article (see ) is limited to the brief statement that "A variety of diagnostic and pathogenetic concepts are questioned and analyzed. Education can be an important part of management." However, for non-subscribers, the full text of the article is posted in the Co-Cure Listserv archive at The listserv posting also indicates that reprints may be requested from Dr. Clauw.

Some Key Points

n The American College of Rheumatology criteria for Fibromyalgia, published in 1990, "have been both bad and good for Fibromyalgia." At the time the criteria were defined, rheumatologists believed greater FM patient "tenderness" or sensitivity to pressure was limited to specific areas of the body called tender points, and that FM was always linked to psychological or behavioral factors. Eleven of 18 tender points was the diagnostic criterion.

n Now, research has shown that all people are more tender in the "tender points," but FM patients have widespread pain and greater tenderness (or stronger "stimulus-response" to pressure) than others throughout their bodies; that FM involves many other bodily or "somatic" symptoms beside pain/tenderness; and that psychological/behavioral factors affect only some FM patients.

n Experts believe FM is not "a discrete illness," but rather part of a wide "continuum of pain and somatic syndromes" that includes irritable bowel syndrome (IBS), temporomandibular joint (TMJ) syndrome, and more. Dr. Clauw views the pharmaceutical industry as a leader in seeing FM as "one large problem" more appropriately addressed in primary care than by separate specialties responsible for symptoms in different parts of the body.

n Further, the tender point-focused diagnosis results in misdiagnosis of many male FM patients. Research shows that, owing to gender-based differences, females with FM are 11 times more likely than male FM patients to test for 11 of 18 tender points. But women are only 1.5 times more likely than men to meet a chronic widespread pain criterion for FM.

n The theory is that the population falls into a genetically-determined ‘bell curve’ for sensitivity to pain (where most of the population falls in the middle with "normal" sensitivity) - and for likelihood, given certain stressors, of developing FM or other illnesses in the pain and somatic syndromes continuum. Stressors include pain caused by damage to or inflammation of tissues; infections, known to include Epstein-Barr virus, parvovirus, Lyme disease, and Q fever (all also implicated as triggers in Chronic Fatigue Syndrome); physical trauma; and war (including the first Gulf War). Data so far are mixed regarding psychological stress as a trigger or exacerbator.

n Dr. Clauw states that there is as much evidence that this spectrum of illnesses has strong genetic or "biologic underpinnings" as that psychiatric illnesses such as bipolar disease and schizophrenia are genetically linked. Yet research on the psychiatric illnesses has been more publicized and "legitimized" in the medical community, gaining them more perceived credibility. Dr. Clauw predicts that this will change only as drugs are identified that help symptoms of Fibromyalgia - and as pharmaceutical companies educate about the condition as part of their marketing.

n There are definitely subgroups of FM patients, likely to represent different therapeutic challenges. Notable types include:

1. “Primary care” patients: They meet ACR tender point criteria but aren’t very tender when more sophisticated measures of pressure-pain threshold are used, and aren’t depressed or anxious. They do fairly well with current treatments.

2. “Tertiary care” or specialist-care FM patients: Besides being tender, they tend to be depressed, “catastrophize” with a negative/pessimistic view of their pain, and don’t feel they can control it. On top of a central nervous system pain processing problem, they embody the consequences of past untreated symptoms and are difficult to help.

3. And a group who are the most tender, yet have a psychological resilience that enables them to cope the best with FM. One question being whether there are ways to help others cope as well as they.

n Another key characteristic of people with Fibromyalgia and other conditions in the continuum is that they are more sensitive not just to painful stimuli but to the entire spectrum of sensory stimuli including sound, smell, bright light, and so on. Dr. Clauw speculates that so-called “multiple chemical sensitivity” should really be called “multiple sensory sensitivity.”

Other Information

The article goes on to review current knowledge and theory regarding:

n Abnormalities in FM patients' pain processing/perception, based on use of sophisticated testing and scanning technologies.

n And the use of various pharmacological and nonpharmacological therapies.

Note: This information has not been evaluated by the FDA. It is for informational purposes only and is not meant to prevent, diagnose, treat, or cure any illness, condition, or disease. It is very important that you make no change in your personal healthcare plan or regimen without researching and discussing it in collaboration with your professional healthcare team.

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Article Comments Post a Comment

Dr. Clauw's Grand Rounds Update on Fibromyalgia Science & Theory
Posted by: FannyFreckles
Apr 18, 2007
Although I agree with most of Dr. Clauw's statements, I have problems with the pharmaceutical companies being termed the "leaders". We have far too many research projects for meds or bandaids as I like to call them. The meds work inconsistently from patient to patient and have varying side effects which complicate the FMS symptoms. The bottom line for pharmaceutical companies is $$$. There is no bonus to them finding a cause or cure because they will lose clients. My bottom line is empirical diagnosis to eliminate the waiting game for patients and research into the cause and cure. We need to focus on, gene marker studies, functional MRIs and their inclusion as standard diagnostic tools for doctors when FMS is suspected. His categorizing of FMS patients is accurate in my opinion. As a member of an FMS support group, subjectively, I had observed similar groupings. But it is hard to differentiate between those FMS categories and normal personality differences. Thanks to Dr. Clauw for analyzing and summarizing what is happening in this field.
Reply Reply

Nail on the head!
Posted by: r47mb
Apr 19, 2007
Thank you Fanny for having the courage to hit the nail on the head! $$$ is the motivation behind everything that has to do with the Pharmaceutical Companies! I just wish Dr. Clauws would have expanded more on the subject of men having FM or CFS! You would not believe the way you are treated by most phycicians. You are nothing but a lazy piece of dirt! In my case that was the conclusion of 22 out of 23 Docs. Get over it, get back to work, quit cheating the system, and my personal favorite is now being a drug seeker! Which follows my records everywhere I go now! I am in my sixth year of my SSDisability fight, and am at the civil level. I don't have much hope left, but my wife believes me. My five-year-old has a hard time understanding but we do the best we can with a crooked system at best, (my last judge dismissed my doctor before the hearing even started and did not allow his testimony) which is against their own rules! I told my Congressman this but since it was not on record they told him that I did not present him as a witness! Which is technically true. Sorry for rambling but you are right! Best of luck to you and yours. Sincerely, Rick.


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