Don L. Goldenberg, M.D., is Chief of Rheumatology at Newton-Wellesley Hospital in Massachusetts and Professor of Medicine at Tufts University School of Medicine. An international authority in the fields of CFS and FM, he has published more than 150 papers in scientific journals. He is author of "Chronic Illness and Uncertainty: A Personal and Professional Guide to Poorly Understood Syndromes" and "Fibromyalgia: A Leading Expert’s Guide to Understanding and Getting Relief from the Pain That Won’t Go Away."
The diagnosis of fibromyalgia no longer takes an average of six years (as previous data has indicated), although there is no hard data on this. Most primary care physicians are much more comfortable with the concept of fibromyalgia and Chronic Fatigue Syndrome than they were 10 years ago.
The overlapping features of fibromyalgia and chronic fatigue syndrome are outlined in a number of chapters in my new book. There is significant overlap in the clinical and demographic features of these two illnesses, and much of this may be related to shared etiologic factors, such as low levels of certain neurohormones including serotonin, or how the body responds to various stressors. I attempt to treat the pain and fatigue in a multidisciplinary fashion and the medications that typically have been useful for one symptom are often useful for another symptom.
Medications I will prescribe as needed include analgesic medications, low doses of medicines to help sleep disturbances, and in many patients, low doses of antidepressants, along with physical therapy are beneficial. I will also recommend counseling and cognitive behavioral therapy, meditation, and yoga, as well as numerous other modalities.
For exercise, I use a combination of cardiovascular fitness training and stretching initially, with later introduction of some strengthening. The program must be carefully individualized and we typically use low-impact cardiovascular activities such as walking, stationary biking or water exercises.
Regarding sleep, I believe it is best approached with a combination of medications and also non-medicinal therapies. Low doses of tricyclic medications such as amitriptyline or medicines such as Klonopin have been useful. It is also important that we exclude any primary sleep disturbances such as sleep apnea and restless legs syndrome.
Over time, the majority of patients that I have treated have improved and 50 to 60 percent of patients feel well or very well. Approximately 10 to 20 percent of patients in most large community survey follow-ups have noted a complete disappearance of fibromyalgia symptoms over time. As with any of these illnesses, the longer the symptoms have been present without a remission occurring, the less likely that one will occur. At this time, I don't believe that there is any "cure" but a multidisciplinary approach, with information and education being the most important, will help patients on the road to optimal improvement.
Patients with fibromyalgia who do not respond to more simple management techniques may often respond to a multidisciplinary approach, which would include structured rehabilitation and cognitive behavioral and stress reduction techniques. These are simply more intensive and focused ways to treat both the mind and body aspects of fibromyalgia. The rehabilitation typically utilizes a physical therapist and often also a doctor of physical medicine and rehabilitation. As mentioned in my book, we have done a number of different studies looking at various types of stress reduction and cognitive behavioral techniques. There are numerous studies demonstrating their efficacy in both fibromyalgia and Chronic Fatigue Syndrome.
The most exciting research that I'm personally involved in is working with my collaborators to better understand the neurohormonal aspects of fibromyalgia. These studies are designed to help us understand why the hypothalamic – pituitary – adrenal system seems to be sluggish in responding to physiologic stresses. We believe that this is important in the brain-body connection. Our other major research involves studies to find better medications in randomized placebo controlled trials.
I believe that information and education is the most important way to empower patients to deal with these difficult illnesses. Obviously, that is what I have attempted to do in detail in my new book, providing both what I consider the most important pieces of information, but at the same time, commenting on the misinformation which confuses people who suffer with these common illnesses. HW
For more information about Fibromyalgia: A Leading Expert’s Guide to Understanding and Getting Relief from the Pain That Won’t Go Away (Perigee/Penguin Putnam, 2002) by Dr. Goldenberg (and to purchase a copy) please visit https://www.immunesupport.com/shop/books.cfm.