By Dr. Jackie Gardner-Nix
It is frustrating for those of you suffering from fibromyalgia (FM) as there is no blood test or biopsy or other investigation that definitively proves you have the condition, and there are still health care professionals who feel it is a vague entity at best. This makes it hard to claim disability from your insurers, who inevitably seem to want a rheumatologist to diagnose it.
A group of health care professionals has developed the Canadian Guidelines to assist in the diagnosis and management of FM, recently published in “Pain Research and Management” which is the pain journal of the Canadian Pain Society. These guidelines have also been endorsed by the Canadian Rheumatology Association.
Reassuringly the first paragraph states:
“Although fibromyalgia (FM) has been recognized as a clinical syndrome for the past two decades, recent neurophysiological evidence of pain dysregulation has provided scientific validation. The controversy surrounding FM stems from the subjective nature of complaints and lack of any defining abnormal biological findings”.
Prevalence rates in Canada are in the order of 2 to 3%, so it is not rare, and it affects women more than men, mostly in middle age, though it can affect all age groups.
Forty two recommendations were made, and the whole document is available on the Canadian Pain Society website (http://fmguidelines.ca). The first recommendation is:
“FM, a condition that can wax and wane over time, should be diagnosed in an individual with diffuse body pain that has been present for at least three months, and who may have symptoms of fatigue, sleep disturbance, cognitive changes, mood disorder, and other somatic symptoms to variable degrees, and when symptoms cannot be explained by any other illness”.
Most importantly the guidelines recommend the diagnosis can be made by the family physician, so that management can be instituted early, to avoid deterioration which might occur during the long wait to see a rheumatologist, which often results only in the same recommendations already made by the family doctor.
There is no magic formula to treat FM. Each person’s management is tailored to the individual. Early mobilization and activity are mandatory, and improved self-care is also an important part of treatment. Sometimes stopping working, to reduce the stress of having to go into work, is the start of the slippery slope to worsening symptoms and deconditioning, as lack of routine and despondency contribute to the slide. As in management of any condition, the sufferer can create a “basket” of strategies and interventions with the help of their health care professionals. Having a well-defined daily routine is part of the basket, particularly with regard to sleep hygiene measures, as the loss of restorative sleep is certainly a major player in the condition of FM.