Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

I Feel Your Central—or Maybe Peripheral—Pain

Like life, many of just don’t know what to make of fibromyalgia.

Like life, many of just don’t know what to make of fibromyalgia. Like love, it means different things to different individuals.

Some say fibromyalgia does not deserve to be called a distinct entity. Many rheumatologists call it a pain disorder. Others see fibromyalgia as a “functional” disorder: functional being a code word in the minds of some for saying nothing is really “wrong” with you. Some geographical areas of the medical field write of fibromyalgia as a syndrome in which the body of the sufferer is in distress, including in this overlapping pie graph other conditions such as chronic fatigue syndrome and irritable bowel syndrome. In 2002, in the journal “Psychosomatic Medicine,” Dr. Kroenke put forth the idea that disorders such as fibromyalgia be classified as so-called physical symptom disoders, allowing for the grading of such symptoms as mild, moderate or severe.

Dr. Wolfe and colleagues, writing in the Journal of Rheumatology in 2011, applied quality of life and psychometric testing to patients satisfying the criteria for fibromyalgia based on the revised 2010 American College of Rheumatology criteria for the classification of fibromyalgia. The research group found that 89 percent of patients positive for fibromyalgia from the 2010 criteria had scores indicating a moderate or severe somatic symptom disorder: an array of different symptoms and symptom severity, including pain. Studies using functional magnetic resonance imaging and similar “objective measures” that we are assured prove the pathological disease state of fibromyalgia may instead just be giving us insights into other (functional and psychological) aspects of the patient with chronic pain.

I have written before about the apparent objectivity and insight into the chronic fibromyalgia pain patient thanks to functional magnetic resonance imaging. However, maybe this testing is telling us nothing of importance. After all, we “see” central sensitization in rheumatoid arthritis, chronic pelvic pain, and low back pain. It is not some unique marker of fibromyalgia activity.

Maybe there are no neurobiologic changes seen with fibromyalgia.

A patient may meet criteria for the diagnosis of fibromyalgia, but many fibromyalgia patients meet criteria for other functional somatic syndromes, not to mention a variety of psychological afflictions. It could be that chronic pain patients do not improve as quickly as we (and they) would like. This might change if the healthcare provider appreciated the spectrum of chronic pain.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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