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 http://www.immunesupport.com/library/showarticle.cfm/id/7920 ) 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 http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0704A&L=CO-CURE&P=R6222&I=-3 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.”
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.