Fibromyalgia Syndrome: A Tangled Web of Controversy.
Dr. Thomas Patavino D.C., MS,F.I.A.M.A.

    In today's ever changing world of healthcare we see the cyclical patterns of discovery and eradication of disease. Conditions that destroyed humanity a hundred years ago are nearly footnotes in history, while others are on the rise and taking their toll on the unfortunate lives that cross their path. In the last decade, we have witnessed the rise of autoimmune conditions such as Lupus, chronic fatigue syndrome and probably the most controversial condition of them all, Fibromyalgia.

     Fibromyalgia is a condition characterized by widespread muscular pain, fatigue, sleep disturbances, gastrointestinal complications and depression. These symptoms must be present for a minimum of 3 months and patients must present with tenderness to palpation in at least 11 out of 18 tender points. The hallmark tender points are located bilaterally in the upper shoulders, medial knee, lateral elbow, the sides of the neck, lateral hips, above the buttocks and the upper portion of the posterior neck. In addition, Fibromyalgia patients often complain of joint pain, headache, restless legs and impaired memory.

      It is estimated that between 3 and 6 million Americans have Fibromyalgia, with 90 % occurring in women according to the American College of Rheumatology and The National Women's Health Center. Herein lies the controversy. Fibromyalgia is what we call a disease of exclusion. There is no specific clinical test to identify Fibromyalgia. The diagnosis is based on the presence of the above-mentioned criteria in addition to ruling out other possible conditions. Conditions such as Lyme's disease, Epstein Barr, Lupus, and Thyroid problems among others have to be definitively ruled out through comprehensive testing. Unfortunately, with no black and white clinical procedures to support the subjective complaints of the patient, many physicians question the numbers of incidence. Without question, many people are misdiagnosed with Fibromyalgia due to incomplete clinical work up and to further add to the problem, some physicians even question if the syndrome exists at all.

     This is probably the hardest thing for a patient to face. Dealing with the pain is difficult enough without the added stress of having a physician question the existence of your condition. Regardless, if there is a diagnostic test or not or if the numbers may be overestimated, the most important fact is overlooked. There are millions of people who suffer with pain that is very real and they deserve to be helped.

In my opinion, I feel Fibromyalgia is a very real condition that is impacting the lives of far too many people and their needs should not be discounted. I think there are probably a lot of people that are misdiagnosed and others that have the condition, that don't realize that their complaints are not a normal part of life. As far as physicians that question the existence, I think it is often easier to discount the presence of something we don't understand, see or have the ability to control. Whether we call it Fibromyalgia, fibrositis, tension myalgis, or disease xyz, the point is you still have a patient suffering from a life altering condition.

     The etiology of the cause of Fibromyalgia is beyond the scope of this article, although common theories believe it is either viral in nature or stemmed from a traumatic occurrence at sometime in life. Current treatments look to balance the neurotransmitters, relieve symptoms of depression and help alleviate pain and sleep complications. Prescription medicine seems to be palliative at best, with long-term results being difficult to obtain with any consistency in many cases. Disappointing success is often the result of the way this condition is approached. Studies are inconclusive, but a multidisciplinary approach of utilizing a team of health care providers including primary care physicians, psychologists, physical therapists, chiropractic physicians, massage therapists and alternative health providers seems to clinically improve the chances of controlling this ever-growing concern.

     Fibromyalgia is a very real problem impacting the lives of millions of people. Finding the right team of compassionate physicians is essential in not only understanding the complexity of the problem, but also determining the appropriate course of action to restore normality of life. If you would like to learn more about Fibromyalgia, Dr. Thomas Patavino will give a lecture titled Coping with Fibromyalgia at 60 Waterbury Road Prospect, CT January 19th, 2005 6pm. Please reserve your seat by 1/14/05 by calling 203-758-7250. For more information Dr. Patavino can be reached at