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Fibromyalgia Medication Draws Praise, Skepticism
by
findingDulcinea Staff
The U.S. Food and Drug Administration approves a medication—Lyrica—to treat fibromyalgia. The existence of this pain syndrome is still under debate.
30-Second Summary
“The day that the FDA approved a drug and we had a public service announcement, my pain became real to people,” said Lynne Matallana, president of the National Fibromyalgia Association, in an interview with The New York Times.
Patients like Matallana say they have endured years of tests, and that their discomfort is often compounded by the shame of being told that the pain is all in their head.
Pain and fatigue characterize fibromyalgia. Last year, the U.S. Food and Drug Administration approved Lyrica to treat fibromyalgia's symptoms. Advocates say this approval recognizes a condition that has long caused patients pain and frustration.
But some physicians question whether fibromyalgia is a true syndrome. There is no conclusive way to diagnose this condition, which is most likely to affect women between the ages of 30 and 60.
One rheumatologist says diagnosing someone with fibromyalgia can make things worse by enabling the patient to think about themselves in terms of an illness.
“These people live under a cloud,” Nortin Hadler, who practices in North Carolina, told the Times. “And the more they seem to be around the medical establishment, the sicker they get.”
Patients like Matallana say they have endured years of tests, and that their discomfort is often compounded by the shame of being told that the pain is all in their head.
Pain and fatigue characterize fibromyalgia. Last year, the U.S. Food and Drug Administration approved Lyrica to treat fibromyalgia's symptoms. Advocates say this approval recognizes a condition that has long caused patients pain and frustration.
But some physicians question whether fibromyalgia is a true syndrome. There is no conclusive way to diagnose this condition, which is most likely to affect women between the ages of 30 and 60.
One rheumatologist says diagnosing someone with fibromyalgia can make things worse by enabling the patient to think about themselves in terms of an illness.
“These people live under a cloud,” Nortin Hadler, who practices in North Carolina, told the Times. “And the more they seem to be around the medical establishment, the sicker they get.”
Headline Links: ‘Drug Approved. Is Disease Real?’
Last year, the FDA allowed the drug Lyrica, which has been approved to treat seizures and diabetic nerve problems, to be used to treat fibromyalgia. Some doctors don’t believe fibromyalgia is a real condition and object to the idea of patients needlessly taking medications that have real side effects. But others see Lyrica as a step toward legitimizing a very real condition that has tormented people for years. “What’s going to happen with fibromyalgia is going to be the exact thing that happened to depression with Prozac,” said Dan Clauw, a professor of medicine at the University of Michigan, in an interview with The New York Times. “These are legitimate problems that need treatments.” Fibromyalgia is a syndrome with a number of symptoms, such as widespread pain in joints, muscles and tissue and fatigue. There is no test to diagnose it, and it has no known cause.
Source: The New York Times (free registration may be required)
Opinion & Analysis: Invisible illness or wastebasket diagnosis?
Doctors from StopPagingMe.com, a site for medical students and residents, call fibromyalgia a “wastebasket diagnosis.” Upon hearing the patient’s symptoms, doctors order a full work-up in fear of medical malpractice. But they don’t suggest that the problem may is psychological when the results come back normal. Instead, "We make up a diagnosis so we have something to label it and thus, something to treat.” This doctor, in an unsigned press release, refuses to be part of it. “There is no tissue diagnosis. No radiologic findings. No typical histology. How, then, can this be classified as a physical illness? I was taught way back in medical school that if it smells like a duck, and walks like a duck, it's probably a duck. Well, I'll tell you what this smells like …”
Source: StopPagingMe.com/PRWeb
In 2002, Arthritis & Rheumatism, a journal, published a study that showed that the brains of people with fibromyalgia responded differently to pain. “What it shows is that the brain response is consistent with what the patients report verbally,” said Richard Gracely, one of the study’s authors, in an interview with WebMD. “Being believed is an extremely important issue for these people. Now these physical findings are emerging, it is gratifying for these patients. We doctors aren't surprised because we already knew. But for the patient, it is just a terrible situation to be in. The general public doesn't really realize that pain can be very severe—and sometimes untreatable—in a person who does not seem to be injured.”
Source: WedMD
Nortin Hadler, a rheumatologist in North Carolina, in a 2003 Journal of Rheumatology editorial, said he was concerned with fibromyalgia advocates’ beliefs that their hypotheses are correct, but unproven, and their treatments needed only a little work before their benefit would be demonstrated. “I am concerned that this approach is causing harm today,” wrote Hadler. He acknowledges that science may yet find something that makes his theories obsolete. He goes on to suggest that people who experience pain all the time “choose to be patients because they have exhausted their wherewithal to cope. If this is so, the complaint of persistent widespread pain should initiate a treatment act quite different from that leading to labeling as [fibromyalgia].” The idea that something may be in a patient’s mind shouldn’t be offensive, he suggests. “Then a patient can stand before a Western physician and say, ‘Doc, I feel awful. Could it be in my mind?’ And that physician would reply, ‘I hope so. That's a lot better than leukemia, or renal failure, or lupus or the like.’”
Source: The Journal of Rheumatology
The story of Cathy Wolfe, a California woman whose life was thrown into disarray by fibromyalgia, is chronicled in a 2003 article for the Arthritis Foundation. It took months of tests and specialists for her to be diagnosed, and one doctor suggested her illness was a way to get attention. “I was so angry. I didn't know how to explain that I didn't need this kind of attention,” Wolfe said. A debate also exists over the treatment philosophy. “Some doctors are saying, ‘I can't buy into this concept that takes symptoms, which in many people are stress-related, and makes them into a disease,’” says Dr. Frederick Wolfe, a rheumatologist who helped define fibromyalgia (and isn’t related to Cathy Wolfe). “It isn't that these people don't hurt or have fatigue. It's whether we say, ‘You have sufficient symptoms to be diseased,’ or whether we say, ‘Let's try to get you over this and get you better.’ Physicians each approach it differently.”
Source: ImmuneSupport.com/the Arthritis Foundation
Background: Fibromyalgia information
The Mayo Clinic introduces fibromyalgia in this way: “You hurt all over, and you frequently feel exhausted. Even after numerous tests, your doctor can't find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia.” The syndrome is not life-threatening, and while it may not get better, it won’t get worse either. The American College of Rheumatology has some guidelines to diagnose fibromyalgia, though no definitive test exists. A person must have “widespread aching pain for at least three months.” A person must also experience tenderness when some pressure is applied to 11 or more spots throughout the body. Besides Lyrica, doctors often prescribe pain medicine and encourage patients to reduce stress in their lives and to sleep more.
Source: The Mayo Clinic
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