There has been a great deal of criticism
regarding the 2010 Preliminary Proposed Criteria for Fibromyalgia, here, and The Modification of the American College of
Rheumatology, here. Besides my own concerns reported on in a blog titled A
Comprehensive Review on the Proposed and Modified Diagnostics for Fibromyalgia, here, you might be interested in seeing what other
clinicians an researchers have to say:
- Enhancing the Diagnosis and Assessment of Fibromyalgia by Lesley M. Arnold, MD, here.
- A report and opinion on the preliminary guidelines for the clinical diagnostic criteria for fibromyalgia by Robert Bennett, MD, here.
- Drs Bennett & Clauw Debate Abandonment of Tender Point Test in Revised FM Diagnostic Criteria, here.
- The Scientific Basis for Understanding Pain in Fibromyalgia by Robert Bennett MD, FRCP, here.
In
July of 2012, the SSA ruled to include Fibromyalgia in the listing of
impairments, here. As an RN, this expert was thrilled that the
SSA has the good sense to use the 1990 criteria and require a physical exam,
something the authors of the new criteria say is not necessary. As always,
functional impairment must be documented using tools such the Residual
Functional Capacity Questionnaire by Dr. Robert Bennett. The new diagnostic
criteria, proposed but in use by some, falls short of assessing patients for
clinical trials and in helping them obtain disability benefits. You can read
more about pain and disability here.
Many
study results are skewed because common comorbid conditions are not ruled out,
the number one culprit is myofascial pain syndrome (MPS), which is known as the
great imitator. Research suggests it is one of the main peripheral pain
generators to the centralization (amplification) of pain in fibromyalgia. It is
also prevalent in other overlapping conditions, such as bruxism, restless leg
syndrome, migraine, bladder and bowel dysfunction, chronic fatigue syndrome,
TMJ and piriformis syndrome. The presence of MPS can also explain some of the
unexplained symptoms of swelling and neuropathy. This is exactly the type of
comment I submitted to the FDA on the upcoming “Public Meeting on Fibromyalgia
Patient-Focused Drug Development” on December 10, 2013, here.
There
is no doubt that fibromyalgia may play a role in neuro, endocrine, and immune
function because of the upset in the command center of the brain and possibly a
broken mechanism in the brain for interpreting pain messages, but to get clear
untainted research, we need good diagnostic criteria, which will only come
about when all these other things are considered and leaving out a physical
exam is no way to go about it.
Is it
any wonder we seem to be chasing the monkey around the barrel?
~ • ~ • ~ • ~ • ~ • ~
All
answers and blogs are based on the author's opinions and writing and are not
meant to replace medical advice.
Celeste
Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the
Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series
(coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia,
Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection
(coauthor, Jeff Miller PhD) She is a fibromyalgia expert for Dr. Oz, et al., at
Sharecare.com, here, and she advocates for all chronic
pain patients as a participant in the Pain Action Alliance to Implement a
National Strategy, here.
You can read more educational information and about her books on her website, http://TheseThree.com
1 comment:
Hi Celeste,
Healthline is interested in contributing a guest post to fmcfstriggerpoints.blogspot.com. We would be open to contributing any blog that would be of interest to your readers. Healthline bloggers have been featured on a variety of sites including:
Washington Times: http://communities.washingtontimes.com/neighborhood/tango-mind-and-emotion/2012/aug/10/how-healthy-choices-easy/
Natural News: http://www.naturalnews.com/036515_diabetes_strawberries_prevention.html
Patch.com: http://strongsville.patch.com/blog_posts/where-and-what-to-eat-in-cleveland-to-beat-the-winter-blues
Please let me know if you have any questions. Thank you in advance for your consideration.
Warm Regards,
Tracy
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