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Some people don’t believe Fibromyalgia is real? Seriously? Take a look at the research

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Important FM summary paper in the Journal of the American Medical Association:​

http://emerge.org.au/wp-content/uploads/2014/12/Clauw-D.-J.-Fibromyalgia-a-clinical-review.-JAMA-J.-Am.-Med.-Assoc.-2014-31115-1547-1555.pdf

The Science of Fibromyalgia:

https://www.mayoclinicproceedings.org/article/S0025-6196(11)65223-3/pdf

fMRI shows distinct reactions to painful stimuli:https://www.ncbi.nlm.nih.gov/pubmed/27583567

People with FM have higher glutamate levels in the brain:https://www.ncbi.nlm.nih.gov/pubmed/18311814

People with fibromyalgia feel pressure as pain:https://www.ncbi.nlm.nih.gov/pubmed/12115241

CSF levels of 3 neurotransmitters (serotonin, norepinephrine, and tryptophan) were found to be lower in people with FM:​https://onlinelibrary.wiley.com/doi/abs/10.1002/art.1780350509

MRI SPECT scans in people with fibromyalgia show decreased blood flow in the thalamus:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337836/

Strong genetic link in fibromyalgia:​https://www.ncbi.nlm.nih.gov/pubmed/23280346

Non brain unique physical findings in people with fibromyalgia:

  1. Link between fibromyalgia and irritable bowel syndrome:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1754959/pdf/v063p00450.pdf
  2. Altered intestinal permeability in fibromyalgia: https://www.ncbi.nlm.nih.gov/pubmed/18540025
  3. Lower amount of intramuscular collagen in people with fibromyalgia:https://academic.oup.com/rheumatology/article/43/1/27/1778588
  4. Trans capillary permeability is reduced in fibromyalgia:https://www.ncbi.nlm.nih.gov/pubmed/7966078/
  5. During exercise muscle oxygen extraction was less in FM patients and the muscle recovery time (how long it took oxygen to normalize in the muscle) took significantly longer compared to people without fibromyalgia:https://www.medscape.com/viewarticle/804318?src=wnl_edit_tpal

City of Hope Research Studies:

  1. 2008 paper ****this study showed that guaifenesin has an effect on immune system proteins (chemokines and cytokine):http://www.fibromyalgiatreatment.com/uploads/2/6/5/7/26574962/city_of_hope_reprint.pdfAnd Dr. St. Amand’s interpretation of the study:http://www.fibromyalgiatreatment.com/uploads/2/6/5/7/26574962/dr_st_amands_explanation_of_city_of_hope_study.pdf
  2. 2010 paper:http://www.fibromyalgiatreatment.com/uploads/2/6/5/7/26574962/fms-plosone.pdf
  3. 2013 paper:http://www.fibromyalgiatreatment.com/uploads/2/6/5/7/26574962/fengetal2013.pdf

Presenting a donation for City of Hope Fibromyalgia Research:

My thoughts on the JAMA article “Fibromyalgia: A Clinical Review” by Daniel Clauw MD Part 2

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I love Dr. Clauw’s article. It is a thoughtful and comprehensive review of fibromyalgia. However, I must take issue with the following:

1. Dr. Clauw states that “rarely” it may be “ill advised” to “provide a diagnosis (of fibromyalgia) for a child or adolescent who might use a fibromyalgia diagnosis as a reason to restrict activities.” WHAT? Firstly, I think it is never OK to withhold a diagnosis of fibromyalgia from anyone. Secondly, it is my job as a fibromyalgia consultant to help fibromyalgia patients of ALL AGES understand the importance of consistent aerobic exercise in reducing symptoms, and I would never let a patient’s dislike of exercise keep me from being honest about a diagnosis. I teach all patients how to begin an exercise program so they can minimize pain and maximize the benefits of exercise (see blog on the “exercise envelope” 8/5/14). Dr. Clauw is not the only specialist who feels this way, and sadly many children and adolescents are denied early treatment because of it.

2. Dr. Clauw states; “Usually, the physical exam is unremarkable in patients with fibromyalgia.” Not in my experience. I have examined hundreds of fibromyalgia patients and they all have a distinct pattern of muscle spasm on exam. If a massage therapist ever said “you have the tightest shoulder muscles ever– your muscles feel like rocks,” then you know what I mean. Fibromyalgia expert Dr. R. Paul St. Amand taught me how to carefully examine the muscles, tendons and ligaments of patients to check for muscle spasm and nodules. I do not expect all doctors to travel to see Dr. St. Amand to learn how to more accurately diagnose fibromyalgia (although that would be wonderful), it it is clear to me that fibromyalgia patients have a “remarkable” exam. I am amazed by how many of my new patients tell me that most of their doctors do not even touch them.

3. I am worried that Dr. Clauw’s recommendations for treating “Ms P” will not be successful. I agree that she should limit her to of cyclobenzaprine to 5-10mg at bedtime (although we don’t know if she is already doing this). Dr. Clauw recommends she take her dose of pregabalin at bedtime, which she states she “usually” already does. Next he recommends she add a serotonin norepinephrine reuptake inhibitor. She is already on TEN prescription medications! I would love to see Dr. Clauw discuss a plan to perhaps start a new medication while decreasing and stopping others. Many of my new patients are on a dozen drugs–yes they can reduce symptoms (usually only temporarily), but they have side effects and they can interact with each other! I totally agree with Dr. Clauw that helping “Ms P” understand how to use non-pharmacological therapies to help treat her fibromyalgia is vitally important.

4. One more issue in closing: Dr. Clauw states “effective treatment for fibromyalgia is now possible.” Yes, I believe that with more fibromyalgia research and more excellent articles on fibromyalgia diagnosis and treatment practitioners will better understand fibromyalgia and its effective treatments, but I think it is important to recognize those practitioners who have ALREADY been successfully treating fibromyalgia for years! Many thanks to them–including Dr. Daniel Clauw.

You can access the article here: http://jama.jamanetwork.com/article.aspx?articleid=1860480