Question: My 44-year-old daughter has been diagnosed with possible fibromyalgia. She has gone to several doctors and specialists, done a lot of research, and has worked hard to get well, but is still getting worse after four years. I would appreciate any and all comments from you.
Dr. Hibberd's Answer:
Fibromyalgia is a chronic painful condition of muscle, tendon, and soft tissues around bone. It is characterized by pain, stiffness and aches not associated with any underlying medical condition. It is important that the gravity of her suffering be appreciated by the consultants she is seeing. Once a complete evaluation has been performed, and no treatable underlying disease discovered, it is important to maintain surveillance for conditions that may not have been evident previously. If she is deteriorating, it clearly is time to re-address her condition since most fibromyalgia does not usually worsen without an underlying disorder.
Consider a general re-evaluation by her primary care doctor then consider a referral to a rheumatologist and a neurologist. Sometimes the pain recognition receptors change in our brains and even light touch may elicit pain. Bear in mind that the mind/body connection is very significant, and she may benefit from psychiatric consultation in conjunction with her other medical consultants, as not all treatments will necessarily involve additional prescription medication.
Some new medications, such as Lyrica and Cymbalta, are very effective for some fibromyalgia patients. These and other antidepressant medications can be very effective at correcting altered pain perception, and are commonly used alone or in conjunction with other medications to relieve discomfort in fibromyalgia patients. Further discussion of treatment options is beyond the scope of this column, and I refer you to your consultants or perhaps to the NIH website for further reliable information (google "fibromyalgia", then select the option preceded by nih in the contents).
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