Fibromyalgia/tenosynovitis .

Few would realise that diagnoses for joint and muscle pain come and go.   I first heard the term fibromyalgia in the early 1990s. My older clients used a similar term, ‘fibrositis,’ for the same symptoms. To add to the confusion,Rheumatologists described widespread muscle pain as ‘Polymyalgia.’    If it affected mostly joints it was called 'Polyarthralgia'. My young clients were also being diagnosed with 'RSI' or 'tenosynovitis'  for the  same set of symptoms. I had been taught to call widespread lingering pain ‘Chronic Pain’ . 

 The term Fibromyalgia   grew in popularity as a diagnosis in America, Europe and Australia,   although many practitioners still don’t recognize it. It describes a set of symptoms rather than explain them.   I don’t know if the British  have capitulated.   I personally prefer not to use it.

At the massive Yokohama 2017 IASP (international association for the study of pain)  conference   I queued to  hear   the latest on ‘Fibromyalgia’ at   a seminar entitled ‘Fibromyalgia: the elephant in the room.’ This implied (I think) it was not a widely recognised as a disease.

The session was introduced by an Australian Rheumatologist who  presented a history of the term. He explained that the term fibrositis was used in the 1935 Australian Test match (or thereabouts).  When the British captain stopped play due to ‘fibrositis’ it engaged the nation. Perhaps it was a ploy? In the national press, making first page news, a doctor Kersley declared it either a  ‘psycho-neurosis’ or a ‘psychosomatic’  disorder. 

According to our speaker,  the term fibromyalgia was ‘invented’ in 1976 by a physician named Hench. I knew it has been promoted by a persuasive American writer/rheumatologist   named   Muhammad Yunus .  But who wanted to quibble ?  

No objective reliable blood test or scans  can detect this disorder. Up to recently, a patient was diagnosed with fibromylagia if they had 19 or so tender (trigger) spots when prodded. It came down  to this: if   someone was experiencing  widespread aches and pains  that  hurt to prod and couldn’t  be explained by x-rays or blood tests  were told they had fibromyalgia.   In other words it was  another way to describe and name unexplained  pain .

Following confusion and controversy about the diagnoses of fibromylagia, in 2011, the IASP decided to introduce a tick point ‘poly symptomatic’ distress score sheet. They   dropped the painful prodding  trigger spots criteria. The criteria included  widespread pain plus sleep, fuzzy headaches, thinking or mood problems. 

The next speaker,    Professor Daniel  Clauw, (Professor of Anaesthesiology,  Medicine and Psychiatry at the University of Michigan), pointed out that these  symptoms are interchangeable with many other painful conditions from osteoarthritis to ankylosing spondylitis  to ‘regional pain syndrome’ (pain mostly in an arm or leg)  and, ‘railway’ spine.  This means that the diagnosis given   depends on what hurts most on the day or what the patient highlights.   If  knee or hip pain is highlighted to an orthopaedic specialist then the diagnosis will be osteoarthritis or impinged hips. See a rheumatologist and the diagnosis will possibly be fibromyalgia or polymalgia. See a neurologist about the   fuzzy headaches and the diagnosis will be migraine. Any   diagnosis of muscle/headache pain , then, describes the location state of pain at the time NOT  what will happen (prognosis)  and they do not explain why it started in the first place. And they do not guide a specialized treatment.

Professor Clauw suggested that Fibromyalgia symptoms (like joint pain) fall on a spectrum. Most people get fibromyalgia aches and pains and fuzzy headaches at some point. These symptoms are not unusual and are usually reversible.   However, if poorly treated and badly explained at the outset, symptoms can develop into a distressing  disability.  He  suggested we should look more carefully at the origins of pain and how the early role of health professionals can be critical to outcomes . He suggested that  practitioners should remember that  most normal people get symptoms of fibromyalgia. And that instead of blaming patients for their pain,   practitioners should   consider them victims of medical and health  failures. He made the point that any condition in which   symptoms are not adequately  treated for several  years   (whether it be asthma or a heart disorder or kidney failure)   will probably lead to  a huge set of serious symptoms that include disability, depression,  anxiety and catastrophic beleifs. Again these can be a CONSEQUENCE of our  medical and health practices and beliefs which  fail to help people  reverse symptoms early.   I agree .

Professor Clauw and others (including  Yunus )speculated   that osteoarthritis and fibromyalgia cause  the central nervous system to become sensitived and over reactive.  He   illustrated his theory with an electric guitar analogy.  A player can make the sound (or the feeling of pain)  louder (hurt more) either by  strumming harder on the strings or turning up the amplification. In   fibromyalgia the perception of pain from the disease become amplified by the nervous system so sufferers experience more  pain with less provocation from the affected muscles or joints. I disagree. I think sensitization creates these syndromes. 

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