Why fibromyalgia has a credibility problem

Crofford said. Diseases such as lupus, thyroid disease, seronegative spondyloarthritis, rheumatoid arthritis, and polymyalgia rheumatica can all cause widespread musculoskeletal pain, but they aren't typically common in the primary care setting, she said. Katz said, as an MRI of the back or neck may show something from long ago that may not be clinically relevant and may lead to further unnecessary testing. Katz said, adding that abnormalities in erythrocyte sedimentation rate and C-reactive protein levels can indicate a different illness.

Erythrocyte sedimentation rate or C-reactive protein tests can rule out polymyalgia rheumatica, particularly if a patient is over 50 years old, said Dr. If a patient has joint symptoms, an internist could also check rheumatoid factor and anti-cyclic citrullinated peptide antibody, and if a patient reports weakness which is not particularly characteristic of fibromyalgia , internists could also check creatine phosphokinase, she said.

If any tests come back positive, a rheumatologist could then evaluate the patient for an autoimmune inflammatory musculoskeletal problem and could work together with the internist on management. The types of treatments that work for peripheral or nociceptive pain, such as nonsteroidal anti-inflammatory drugs, opioids, injections, and surgery, won't work for the centralized pain that occurs in fibromyalgia, Dr.

Instead, experts agreed that the first step is educating patients about what fibromyalgia is and what it isn't. Next should be some kind of encouragement or prescription for light exercise to increase heart rate, or referral to physical therapy, experts said.

A Cochrane review of 34 studies found moderate-quality evidence that aerobic-only exercise training has positive effects on global well-being and physical function in fibromyalgia patients. Evidence suggests that an online form of self-management with cognitive behavioral therapy CBT is helpful, Dr. But Dr. Crofford noted that patients with fibromyalgia often use up their will-power to get through the day with chronic pain and may benefit from the guidance of a professional.

For patients with psycho-social stressors or those who are having difficulty coping with symptoms, another challenge is finding a therapist who is comfortable with CBT approaches and patients with chronic pain, she added.

If nonpharmacological treatments are not enough, select medications can be used to tackle patients' most prominent symptoms. Although the FDA has approved 3 drugs for fibromyalgia—pregabalin Lyrica in , duloxetine hydrochloride Cymbalta in , and milnacipran HCl Savella in —these medications have a relatively low effect size and carry the risk of adverse effects.

Clauw said his favorite medications to start with are tricyclic antidepressants such as amitriptyline or cyclobenzaprine at bedtime to help with sleep and pain. Katz said he'll begin with amitriptyline, doxepin, or trazadone at a low dose at 6 or 7 p. If patients don't improve on a tricyclic drug, Dr. Clauw said he'll add either a gabapentinoid, such as gabapentin or pregabalin, or a serotonin-norepinephrine reuptake inhibitor SNRI , such as duloxetine or milnacipran.

This second therapy depends on a patient's most bothersome symptoms: Go the gabapentinoid route for sleep problems, pain, and anxiety, or choose an SNRI for depression, fatigue, and memory problems, he recommended. Clauw added that in a small randomized controlled trial, published in the July issue of Pain , patients achieved better overall symptom control with a combination of a gabapentinoid and an SNRI than with placebo or either agent alone.

In the trial, dual therapy was associated with side effects such as moderate-to-severe drowsiness, and patients could tolerate only small amounts of each drug. Katz said he hasn't had much success with pregabalin, duloxetine, and milnacipran. One of the biggest challenges in managing fibromyalgia, Dr. Crofford said, is obtaining a complete medical history and understanding the day-to-day lives of these patients in a to minute office visit.

MetLife, F. After crediting the diagnosis of fibromyalgia, without evidence the insured was exaggerating or misrepresenting her complaints, Liberty therefore had no basis for terminating benefits. This court cannot imagine any occupation that such a person could fill successfully, much less an employer who would be willing to hire him. Egghead Software Disability Plans, 64 F. Thus, the issue is one of credibility rather than specific medical findings. That makes no sense either. Several courts have specifically remarked on the uselessness of such testing for a condition marked by variable symptoms: Brown v.

Continental Casualty Co. Litton Industries, WL M. Ohio Likewise, a district court found that a neuropsychological evaluation would be of questionable validity in evaluating a physical illness such as chronic fatigue syndrome in Sansevera v. DuPont, F. Nord, U. Simply because a plan administrator retains a medical consultant, even one who practices in a relevant specialty, does not automatically mean the evidence is reliable.

Perales, U. Gehin v. Wisconsin Group Insurance Bd. See, Perlman v. Swiss Bank Corp. Prudential Ins. Federal Rule of Evidence requires, as a condition of witness competency, first hand knowledge. Although it is permissible under FRE and for a witness to testify as an expert without first hand knowledge, absent a clinical examination, the doctors in this case were not presenting reliable evidence in the same manner as a physician who is interpreting an x-ray or an electro-diagnostic test such as an electrocardiogram.

This point was emphasized in Sheehan v. Rachel Hannah, a certified neuromuscular and biodynamic CranioSacral therapist based in Northampton, spoke about the biological origins of fibromyalgia. When the fascia dehydrates and becomes restricted, it creates pain, nerve sensations and limits motion. Still, there are ways to soothe the restricted collagen that forms fascia. But each case of fibromyalgia is as unique as people.

Symptom relief can be found in the offices of professionals like Hannah, but she also pointed to some supplemental home remedies, like foam rolling and stretching.