Fibromyalgia: The Answer Is Blowin' in the Wind
pathology do not correlate: headache, migraine headache, trigeminal neuralgia, phantom limb pain, kidney stones, and the Charcot joint. We cannot and should not fool ourselves into believing that we can estimate another individual's pain. One day, technology capable of measuring the pain of others will exist, but it does not exist - at least for use in clinical practice - at the time of this writing. We all will have to wait.
No one can reasonably justify the zealous anti-FM movement by arguing that there are no objective physical findings among FM patients. First of all, there are many well accepted disorders that lack objective physical findings. The same physicians who have such difficulty understanding and accepting FM have no problems at all injecting or operating on patients with de Quervain's tenosynovitis, medial and lateral epicondylitis, rotator cuff tendonitis, and greater trochanteric bursitis, despite the utter absence of any "objective" physical findings in any of these conditions.
Tenderness, certainly, cannot be considered "objective." And yet, it is one of the mainstays of physical examination, be it of the teeth, the abdomen, the muscles, the joints, or elsewhere.
Moreover, should we be any less believing when we identify tenderness on examination, than we should be when we identify alterations in sensation, cognition, or strength? Again, we badger our medical students on the importance of examining for all of these. Why? Why, indeed, if these "non-objective" findings are not fit to be believed anyway?
Many FM patients do have measurable alterations in skin tissue compliance and reactive hyperemia, findings that are measurable and objective(8). FM naysayers pay no attention to this, perhaps claiming that these are nonspecific findings that, further, many patients with FM do not have. And yet I have observed the same physicians enthusiastically gather around them a horde of medical students to demonstrate livedo reticularis as a sign of systemic lupus erythematosus (SLE).
The acidic reaction towards FM cannot be justified by arguing that there are no pathophysiologic changes in FM patients. To begin with, for years there has been a large and rapidly expanding body of scientific evidence demonstrating numerous pathophysiologic differences between FM patients and healthy controls. As early as the late 1970s, Moldofsky was reporting alterations in brain wave activity in Stage IV sleep, alterations found in other chronic pain states but not in dysthymia(9). These findings have been replicated many times over, and most recent research has found that alpha wave intrusion into Stage IV sleep is predictive of symptom severity(10). How possibly could FM research subjects manipulate these results? The answer is that they
Latest Articles