Sharon B. Stanford, MD is the Assistant Professor of Psychiatry and Family Medicine, Assistant Director, Women’s Health Research Program, University of Cincinnati College of Medicine. The article is partly an examination of the current drugs approved and used in the treatment of Fibromyalgia, and Dr. Stanford discloses that she receives grant/research support from several drug companies, but beyond the drug exploration, Dr. Stanford has written a very accurate and empathetic report on Fibromyalgia. She even touches on a recent conversation we had here on FibroHaven – which came first, the pain or the emotion. 

Stanford offers Ms. D as a cases study:

Ms. D, age 50, has a history of migraine headaches and is referred by her primary physician for evaluation of depression and anxiety. She reports deteriorating mood over 6 months, beginning when a minor car accident left her “very sore the next day.”

“Nothing helps” the persistent pain in her back, shoulders, and thighs, which she rates as 7 to 8 on a 0-to-10 pain scale. She describes an intense ache, “like having the flu,” that worsens with activity and in stressful situations. She also experiences nausea and intermittent diarrhea, debilitating fatigue, and sleep disturbance.

Ms. D reports she is depressed because she feels “just too tired” after work to keep up with social activities or housework. Her physician’s referral notes a normal physical exam except for tenderness over her upper back and hips. Laboratory testing is negative.

As you elicit more details about Ms. D’s mood, she continues to focus on her physical symptoms. She states that some days she wishes to die because her pain gets so bad, but she denies any plan or intent to harm herself. She worries that her symptoms will worsen and that she will become completely disabled.

Her primary physician attempted to relieve Ms. D’s pain with multiple trials of nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclobenzaprine. She says she gained no benefit from the NSAIDs and discontinued the muscle relaxant because it made her too sleepy.

 

Sound familiar? We all understand the horrible cycle of pain Ms. D is in and the frustration she is experiencing just hoping and looking for some relief. Dr. Stanford is frustrated too and here is the treatment she proposes for Fibromyalgia patients.

TREATING THE WHOLE PATIENT

As a clinician who specializes in fibromyalgia, I counteract my patients’ and my own frustration with this condition by structuring office visits, determining realistic treatment goals, and treating all symptoms as part of a common syndrome rather than individual illnesses.

Structure office visits. Before every visit, have patients rate each symptom domain and write their top 2 or 3 concerns for that day (Click here for a sample form). Focusing on the patient’s most troublesome symptoms can help both of you feel greater satisfaction with treatment.

Educate patients. Ask them to discuss their beliefs about fibromyalgia; many know others with this condition or have researched diagnosis and treatment. Before developing a treatment plan, explain that their symptoms are chronic and all part of the same syndrome. Describe their pain as a complex phenomenon with possible peripheral and CNS components. Guide them to reputable Web sites and resources (see Related Resources).

Set realistic expectations. Many patients expect to resume an energetic and pain-free life, which usually is not the case with fibromyalgia (Box). Most medications are considered successful if they reduce pain by 30% to 50%, and side effects can be problematic. Discuss side effects before treatment begins to reduce patients’ anxiety and improve compliance in the first weeks.

Cognitive-behavioral therapy (CBT) for fibromyalgia incorporates relaxation techniques, helping patients view symptoms as manageable, reinforcing adaptive coping skills, and teaching them how to monitor thoughts, feelings, and behavior to change the view that they are helpless victims. A modest course of 6 weekly group CBT sessions significantly improved physical functioning in 25% of fibromyalgia patients (n=76) compared with 12% in a standard-care group (n=69), even though patients’ pain severity did not improve.¹⁶

Recommend exercise, lifestyle changes. Aerobic exercise can significantly improve well-being and physical functioning in fibromyalgia patients.¹⁷ Low-impact aerobics, such as done in warm water, usually are well tolerated, although any low-impact exercise can help. Because fibromyalgia symptoms often increase with physical activity, counsel patients to begin with a few minutes daily and increase very slowly each week.

 

Lifestyle changes are as important as medications in controlling fibromyalgia symptoms. In addition to exercise, recommend that patients:

• follow a daily routine
• pace activity to avoid exacerbating symptoms
• reduce stress.

Sometimes, I use the analogy of diabetes: treating fibromyalgia with medication but without changing lifestyle is like prescribing medication for a diabetic patient without changing diet. Follow up on this “homework” at each visit to reinforce that patients helping themselves is an important part of treatment.

 

 

There is nothing “murky” about Dr. Stanford’s approach to Fibromyalgia. I appreciate that her approach is to treat the WHOLE patient, not just individual symptoms, and she provides resources to help the patient and the doctor. Click on the sample form above. I think it is a great tool to use before any doctors visit. How often do we forget or feel too rushed to cover everything we intended at an appointment? This sheet will help improve communication between patient and doctor. The link to the box is also a useful summary on managing unrealistic expectations of Fibromyalgia patients. It is worth the read.

Even though I chose drug-free management for my Fibromyalgia, I was able to appreciate Dr. Stanford’s article very much. She clearly cares and is invested in helping her Fibromyalgia patients. Her article will help countless other psychiatrists treat their FM patients as well. And it is another step forward in promoting Fibromyalgia Awareness and Visibility.

In January of this year they began a campaign called Pledge to Care. The Pledge to Care is a way for family members, friends, and healthcare providers to show their support to persons with Fibromyalgia by making a simple pledge.

“Fibromyalgia is a chronic pain  disorder that affects 6 to 10 million Americans, however recent health care reform legislation and biased attitudes towards people with fibromyalgia, continue to prevent them from receiving adequate and appropriate access to medical care,” said Lynne Matallana, president and founder of the National Fibromyalgia Association. “Family members and other caregivers play an important role in the treatment of the person with fibromyalgia, yet many are still not well informed or know how best to care for their loved one. The ‘Fibromyalgia Pledge to Care’ is designed to help raise awareness for fibromyalgia, and provide a tool which will encourage others to join us in our national efforts to insure fibromyalgia patients access to better medical care.”

 

By going to NFA’s website and filling out a simple form, you can join a long list of family members and friends who have already made this pledge. Fibromyalgia is still known as “the invisible illness.”  It is invisible not just because it does not show up on an x-ray or blood test, but it is invisible because it is easy to dismiss or ignore what is not understood. The NFA has made it their mission to develop and execute programs to educate and inform, because with understanding comes compassion, and with compassion there can be progress.

I hope you will all go to the NFA website and complete the Pledge to Care form in support of someone you love who suffers from Fibromyalgia. If it is you that suffers from Fibromyalgia, take the time to direct someone you love to the NFA site and ask them to make this pledge for you. It could be a good step towards educating them about Fibromyalgia and the very real challenges you face every day.

For my family and friends, I would appreciate very much if you took the time to make a pledge for me.  I am very lucky to have such a loving and compassionate support system, but I know that I too could do more to help you understand the realities of Fibromyalgia.  This blog has been a big step for me in that direction.  Now I am taking it a little further and asking you to make a Pledge to Care. If you do make a pledge I would love if you came back here and posted a comment to let me know, or send me an e-mail if you prefer.  Thank you!

UPDATE:

Coincidence! On the same day I wrote a post about The National Fibromyalgia Association, my friend over at The Girl From the Ghetto did the same. Great minds! Check out her comment and then click the link to read her post.

thegirlfromtheghetto

You have got to read my latest post. You can shop @ amazon.com & This organization gets 15% of your sales!!! Feel free to borrow my post and put it here on your site.

http://thegirlfromtheghetto.wordpress.com/2008/12/11/going-to-online-shop-you-can-give-the-national-fibromyalgia-association-15-of-your-sales/