Abstract
Fibromyalgia is one of the most common causes of widespread pain. According to some statistics, fibromyalgia patients represent 2-5 % of the general population in the United States. In Israel 10-20% of patients are sent to rheumatologists, and more than 40% of the patients are seen in the pain clinics.
In the past, the “Fibromyalgia” entity was attributed and referred to, by many names, some of which are: Fibro-myositis, Fibrositis, Muscular Rheumatism, Musculoskeletal Pain Syndrome, non-articular rheumatism, Periarticular Fibrositis, Rheumatoid Myositis, Tension Myalgia, etc... During a long while “Fibromyalgia” was considered as a rheumatological affection, and is still done by many. These patients experience tremendous frustration secondary to delayed diagnosis generally between 2-7 years, since all the tests seem to be normal.
As of January 1st 2019, the International Association for the study of Pain (IASP) delivered a new Classification of Chronic Pain for the ICD-11 (International Classification of Diseases), and Fibromyalgia is recognized after many years to be a “Chronic Primary Pain disease” on its own, it can now be the sole or leading complaint that requires special treatment and care.
Today It is known that Fibromyalgia is neither a Psychiatric Disease, nor a Rheumatological Disease. Fibromyalgia is associated with very large number of symptoms, the primary being pain, significant fatigue, insomnia, loss of memory, depression, progressive loss of physical ability, social isolation and loss of all pleasures (anhedonia), etc. Many of these patients became drug addicted due to easy administration of opioids. These patients not only become unable to work, but progressively lose their autonomy.
Many Doctors are still not familiar with this entity, considering these depressed patients as having a “Psychiatric Disorder”. We understand that not every “Brain Dysfunction” is a Psychiatric Disease. The peripheral hypersensitivity of the sensorial and/or the autonomic nervous system, experienced by these patients may be in fact due to “Central brain hypersensitive networks”. This abnormal hypersensitivity causes an amplified and exaggerated response to any stimulation of possible signals: physiologic, pathologic, external, internal, physical, social or mental. In the majority of cases, the “trigger” exists and must be detected.
In order to treat these patients, we also need to reduce, attenuate or stop these disturbing stimuli and to “reeducate” the exaggerated “amplified” brain response involving the ascending and the descending pathways. Fibromyalgia is a complex disease that requires compassion and understanding. All these should be diagnosed and considered through a multidisciplinary and multi-dimensional approach. Many Doctors are not “ready” to deal alone with this “time and energy consuming” entity.
The “Integrative Medicine” becomes essential. It requires a synchronized multi-disciplinary knowledge and cooperation, with much patience, and an adequate new structure. “Integrative Medicine” should take into consideration the person as a whole, his actual and past environment, Including all aspects of his lifestyle and environment: familial, social, work, hobby, etc…
Fibromyalgia is a syndrome that does not belong to any existing discipline of medicine, it is not a subspecialty, and as mentioned above, fibromyalgia is recognized to be a “Chronic Primary Pain disease”. This disease implies the involvement of specialists from various areas, and in the same time, it needs dedicated personnel newly formed in this particular domain, having a multilateral and integrative vision for the diagnosis, treatment and for long run understanding, care and support. New Formation and education are needed, in order to deal correctly with this entity, since It is becoming a new field by itself. In the future, instead of wandering between various specialists related only to the symptoms, these patients should have a single referral address of “Fibromyalgia Center” specialized in this entity.
