Editor’s Note: This taped lecture of approx 1.5 hours is produced by the National Fibromyalgia Partnership, Inc. I. Jon Russell, MD, PhD is Associate Professor of Medicine at the University of Texas Health Science Center, where he is also Director of the University Clinical Research center. He is also the editor of the ‘Journal of Musculoskeletal Pain’ and a widely acknowledged authority on fibromyalgia.
The lecture was given on March 25, 2001, when Dr. Russell gave a presentation to the National Fibromyalgia Partnership, Inc. The NFP has been in existence since 1992 (formerly known as the FM Assoc. of Northern Virginia and then as the FM Assoc. of Greater Washington), and has now evolved into a large non-profit association offering a wide array of services and activities to FM patients and professionals. The two-tape set is available for purchase from ImmuneSupport. Click here for more info
I. Jon Russell, MD, PhD, became interested in Fibromyalgia research very early on in his medical career. In many ways, he was a pioneer, beginning his path at a time when FM was barely named, let alone recognized by the medical establishment. In fact, in those dark days he was able to make presentations on FM in fifteen minutes. Now, he is glad to report, he usually asks for four hours.
It is clear from this taped lecture that Dr. Russell’s pioneering spirit continues on in all his work today. Daniel Clauw, MD, in his introduction to the lecture, says that Jon Russell "helped define what FM is,” and recognizes him as “a leader in this field.”
On tape, Dr. Russell sounds like the kind of doctor you’d want to see all the time. His speech is well-paced with a friendly and firm tone, and his technical explanations manage the seemingly impossible task of clarity without any loss of important information.
In the first half of the lecture he provides an overview of symptoms and diagnosis of Fibromyalgia. It is clear that along the way, Russell has really struggled with the medical establishment’s views on FM and lack of support by way of research and recognition. Yet his opening remarks connect up the ‘us’ and ‘them’ of patient and doctor, when he compares patients’ frustration with FM with doctors’ frustration: “FM is a very difficult problem for people who have FM. Many physicians experience it as a difficult problem too, because they like to be able to ‘win’…many are frustrated by the difficulty in doing that.” He goes on to emphasize that many physicians are scared of the disease, as they don’t know how to successfully treat it. This, he said, needs to change. Doctors need to face up to the disease, to end their fear of it.
Russell discusses the ‘invisibility’ of FM and draws frequent medical comparisons to disorders commonly classified as similar to FM, such as rheumatoid arthritis, systemic lupus and others. He carefully explains the differences and the difficulties specific to FM.
It may come as a surprise to some listeners to hear that FM is not hard to diagnose. Russell was one of the first doctors to narrow down the criteria for diagnosing FM, which he describes as only two criteria. One is the patient’s verbal medical history. They have to report having pain for at least three months. The second criteria is the physical exam. Not so simple, you may think. But, according to Russell’s description of finding tender point pain there could be no doubt. How much pressure is the required four kilograms of pressure? Enough to make the color of the blood in your thumbnail disappear when you press on the tender points. A healthy person has no pain at all when the tender points are pressed.
The doctor illustrates his talk with data drawn from the many studies he has led; for example, Russell conducted extensive research on his criteria for FM diagnosis. He had colleagues who did not know a patient’s diagnosis examine patients using his FM protocol, to see if they could correctly identify FM patients. This was carried out on a large scale with many doctors and many types of patient. All the data was collected and computerized to show what the best examination features were for distinguishing FM from other disorders.
In among the enlightening facts and data are comprehensive descriptions of some of the physical processes that lie at the core of FM. His description of the pain response, the importance of Substance P and the role of neurochemicals, is authoritative.
Although Russell is an expert in pain and pain processes he also covers several other areas of interest in his lecture. He discusses the type of depression that FM patients suffer, versus other types of depression in other disorders. He talks about fatigue and genetics as well as the cost of FM to the US economy. There is also an interesting question and answer session at the end of the tape.
No matter how much you know about FM, there will certainly be something in this talk that is completely new to you. Chances are some of the data presented will surprise you. This lecture will definitely inform and educate whoever listens to it.