A new test may help diagnose the controversial fibromyalgia.

by James Hubbard, M.D., M.P.H.

When some say a disease doesn’t exist and others have no test to prove it does, those suffering have problems.

So it’s gone with fibromyalgia, a syndrome that causes ongoing muscle pain and fatigue, along with various other symptoms like decreased concentration and sleep disturbance. There is no objective test for diagnosis.

Some doctors think fibromyalgia is a variation of physical symptoms of depression; others don’t think it exists at all, as a disease.  But people suffer, mostly women.

Now, a new study gives hope. What if fibromyalgia really is all in your head?

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Fibromyalgia Diagnosis Today

To be diagnosed with fibromyalgia, the American College of Rheumatology says you must have ongoing muscle pain, along with tenderness in at least 11 of 18 specific areas of the body.  There are a lot of critics who say this criteria is too constricting, and some say it is too liberal.  What about the patient who hurts everywhere you touch?

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The New Fibromyalgia Study

A French study in The Journal of Nuclear Medicine has shown that in people with fibromyalgia, the brain blood flow increases to areas that discriminate pain.  They injected radioactive material and then used single-photon-emission computed tomography (SPECT), which locates the material’s accumulation, looks at blood flow and determines areas of increased brain activity.

In the 20 studied fibromyalgia patients, the brain was more active in the pain discrimination areas than it was in the 10 volunteers with no symptoms.  The ones with more symptoms had more activity–an important finding to determine association.

So this is encouraging in researchers’ quests toward making a definite diagnosis and finding the cause and treatments.  But it is another study of association, so more specific studies will determine if it’s a breakthrough.

Do you have, or know someone with, fibromyalgia?  Do you think it is an actual disease?  What do you think about the new findings? Please share below.

 

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22 Responses to “A new test may help diagnose the controversial fibromyalgia.”

  1. TB--Milwaukee Says:

    RYC~Thanks for your concern. I did get my eye checked and it’s getting much better.

    TB–Milwaukees last blog post..Staying Healthy While Not Feeling Well

  2. James Hubbard, M.D., M.P.H. Says:

    Glad to hear it.

  3. Miz LIz Says:

    Dr. Hubbard – not sure that I get the point of the findings. What exactly is brain activity indicating? That the fibromyalgia symptoms are manufactured? Or that there is more brain activity in the pain regions because it’s a legitimate complaint.

    For years, women have been told that their [fill in the blank] is all in their head. So, is this study something that is going to validate their complaints?

  4. Chuck Simmins Says:

    It looks like the study is suggesting that an abnormality of some sort in the pain discrimination areas may be at the root of the problem. That doesn’t mean that it is invented. It means that there may be a purely neurological cause for the pain, not a neuro-muscular.

    I would like to see a much larger study, and some physical findings after autopsy to be more confident.

  5. Steve Parker, M.D. Says:

    The study shows that fibromyalgia patients “have something going on in the brain” that can be detected by SPECT scanning, compared to healthy pain-free people. Not addresssed in the abstract is whether people with other sources of pain, such as cancer or rheumatoid arthritis, have similar scans. For all I know, simply imagining being in pain could light up these scans.

    I never doubt the reality of fibromyalgia, and rarely question the reality of pain reported by my FM patients. Telling a fibromyalgia sufferer that “it’s not real” is not helpful, and is a disservice.

    On the other hand, I have run across a few patients involved with litigation or trying to “get on disability” who may or may not have actual pain. In other words, they may be lying to get a cash settlement or monthly check. It would be nice to have a scan that could prove someone is in pain.

    Steve Parker, M.D.s last blog post..Gastric Banding Versus Bypass: Which Is Better?

  6. James Hubbard, M.D., M.P.H. Says:

    Miz Liz,
    I hope Chuck and Steve answered your question.
    The study suggests that there is a real, physical cause that researchers can sink their teeth into. In doctor thinking, a syndrome, like fibromyalgia, is a bunch of symptoms that patients have in common. But what is the cause? We like objective findings to corroborate subjective symptoms. It helps us study and treat knowing that someone has a specific disease. For instance muscle pain and fatigue could be due to low thyroid or calcium, infection, depression or fibromyalgia to name a few. Each are treated differently.
    These findings of changes in blood flow,show something different is going on in the brain with fibromyalgia patients. Something not seen otherwise. What exactly that means is unknown (maybe their brain perceives pain differently?) but it is demonstrable and make sense toward the diagnosis, will help lead toward the cause and treatment.

    It definitely is a step in verifying their complaints.

  7. Gary Patton Says:

    Thank you or your questions, Dr. James.

    I had what’s now being called Chronic Fatigue and Immune Deficiency Syndrome (CFIDS) from 1995-1999. Many FM suffers also have what I had, friends with it tell me.

    Back in 1995, my immune system was ravaged by a 100% gangrenous Gall Bladder. The gangrene almost killed me before the Doctors found the dead Gall Bladder because I had no pain, just increasing fatigue until almost too late. (At age 55, you can guess to what the fatigue was attributed by every specialist I went to for help.)

    It took me over four years to recover from the poisoning and subsequent surgery. During this time, I could not work as a sole-practitioner who owned my own consulting practice.

    In the midst of this trial, my wife was diagnosed with life-threatening colon cancer.

    Back then, most doctors thought CFIDS was psychosomatic like some today feel FM is. Then, it also was not a recognized claim under the disability provisions of our Canada Pension Plan as it is now. (It’s not fun feeling exhausted all the time while living with no income for over four years near a world-class city like Toronto, Canada.)

    Dr. Parker and physicians like him are to be commended because of their attitude towards, and concern for the feelings, of FM suffers.

    Until you’ve been there, you’ll never know what it’s like to have a disease for which no allopathic or natural health care practitioner can tell you what’s really wrong. Let alone offer any real help. (And I consulted every specialist and took ever multi-level marketing cure I could find …to no avail.)

    The funny looks from some so-called friends were hard to take. But, the interminable advice from too many, probably well-meaning, but unthinking, Christians that I just needed to have more faith or pray more or read my Bible more were, for me, the hardest things to bear during my four+ year recovery. Regrettably, both Karen and I only got more of the same while I nursed her and she fought cancer.

    My loving heavenly Father, however, He was great!

    And He saw us both through! Just like He promises all CFIDS and FM suffers in 1 Corinthians 10:13 in which the Greek for “temptation” also means “trial” at http://tinyurl.com/5qv8v8.

    For Karen, Jesus led her to complete recovery in under four months. For me, He took me back to full-time work at age 59 after not too much longer …once the stress of Karen’s illness dissipated.

    If you’d like to read about the simple and inexpensive lifestyle change that led to both our healing, check out our short story at http://tinyurl.com/4f5ggp

    Dr. James, you also asked what I think about the new findings. Well, I don’t think much!

    So-called findings that offer no real hope and effectively tease people who’ve already been sick for years with an expectancy of only a possible route to an unknown cure, if more money for more study is provided, some might say even borders on cruelty.

    Regards,

    @GaryFPatton
    The People Development Guy in Toronto

    Gary Pattons last blog post..Welcome!

  8. James Hubbard, M.D., M.P.H. Says:

    Thanks for you sharing your experience and perspective,Gary.

  9. Sagan Says:

    This is very interesting. And if it is the case that it’s “in your head”, then the treatment required would be of a different sort.

    Many different diseases and disorders are debated about whether or not they’re psychological. But I don’t think it really matters- it’s still having a huge impact on the persons life and needs some kind of cure. It’s still a reality that the people with it have to deal with on a day-to-day basis!

    Sagans last blog post..Life Lessons: Overdoing it

  10. James Hubbard, M.D., M.P.H. Says:

    Sagan, I agree. There is a bias against a psychological illness, but it is very real and can be as debilitating as any physical disease. Some people feel guilty, humiliated or ashamed with a psychologic diagnosis, but there is no reason to be, any more than if you have cancer or diabetes.

    However this new study suggests that fibromyalgia is a physical disease, not psychological.

    Thanks for your input.

  11. James Hubbard, M.D., M.P.H. Says:

    I would add that most psychological diseases can affect you physically and vice versa.

  12. Cynthia Says:

    Please excuse my writing, if it seems like rambling.

    I became very sick in 1990 after a severe emotional trauma. I had a bunch of things “wrong” with me, including sleeping almost around the clock, no energy, etc. etc. etc.

    I went through 7 Drs. who had no clue as to what was happening. I hurt a great deal. The next phase came in summertime – nausea and itching . I was diagnosed as being pregnant, even though tests were negative. The heat would cause extreme itching. When I talked to one Dr. about the nausea etc., he told me to “see a shrink, lady, you’re nuts. Nobody has all those problems.” So I went back to the original group of doctors who took care of my family. That’s when a wonderful doctor who is an osteopath found my 1st diagnosis through blood work: EBV – Epstein/Barr virus. Six months later, the pain began to increase. When he found I had most of the trigger points, the diagnosis became CFS. I picked up food allergies and then in 1992 – tentative diagnosis was Fibromyalgia.

    My immune system seemed to have died. Concentration at times was a problem.

    About 5 yrs. ago, I went out to lunch with a friend. We had the same food, but within hours, I was on my way through 9 days of Hell – food poisoning. Diagnosis: Capybolactor (sp?). Seems somebody might have been working with raw chicken and didn’t wash their hands before plating my food. My friend had no problems.

    I found help for all of my problems with L-Lysine (500 mg., 4 x a day) and acidolpholus (again, sp?).

    With that type of food poisoning, 3 things can happen: you die; you get Guillian-Barre Syndrome (paralyzed) or arthritis. I got the arthritis – on top of the fibro. Now I can not walk far or stand for any length of time. I often can’t go out without having somebody with me.

    I no longer have to sleep during the day, but now sleep very little at night. Concentration is better than it was…

    To top it all off, in the past month, I have been diagnosed as diabetic.

    When I tell my story to folks, I get words or looks of disbelief. I want to say, “you know what?” NOBODY in their right mind would choose to live the way I now have to.

    It’s as though somebody had set up rows of dominos, and when one fell, the next one went and so on…

    18 years of doctors, tests, and no hope in sight. I’m 65 now and I would like very much for someone to believe that these things are REAL. I also know I am not the only one who has to live this way.

    Dr. Parker wrote above: “It would be nice to have a scan that could prove someone is in pain.”

    Yes, it would, Dr. If for nothing else than to rub it in some of those doctor’s faces that called me crazy – but you know what? They probably still would refuse to accept the fact that they are not correct…

    I am so tired, so tired of hurting, and tired of not being able to do much of anything, including holding my grandchildren or playing with them.

  13. James Hubbard, M.D., M.P.H. Says:

    Cynthia,
    It sounds like you have had a very difficult time. As you know modern medicine does not have all the answers or all the cures. I wish you well.

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  15. Teresa Says:

    Some people feel guilty, humiliated or ashamed with a psychologic diagnosis

    Perhaps the reason for that can be found in your previous sentence:
    There is a bias against a psychological illness

    The real problem with a psychological diagnosis is that the patient may know without a doubt that it is not psychological in origin, yet no psychologist/psychiatrist will ever send a patient back to medicine saying, “I can’t find anything wrong with him.” Doesn’t that trouble you, if you are in the medical profession? Why is a negative diagnosis from medicine so much easier to arrive at than one from psychiatry?

    And yes, I have had doctors try to treat me psychologically for an illness that turned out to have a genuine physical cause. It wasn’t until I found a doctor willing to look under more than one rock that the problem was actually discovered. Sheesh. I resisted the psychological diagnosis, because there is no return to medicine from that without new symptoms. It’s a black hole that I was very wise to avoid. Guilty, humiliated, or ashamed? No. Wary? Very.

  16. James Hubbard Says:

    Good points, Teresa.

    You have experience from a viewpoint I don’t have. I would expect that a psychologist/psychiatrist to, indeed, send back a patient if they can’t find anything wrong and to certainly report back to the referring physician if they don’t think the physical symptoms are related to the psych symptoms, or if the physical symptoms don’t improve. Many times there are 2 things going on.

    Thanks for the comments.

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  18. sharlene nelezen Says:

    i am like cyntha i have fybromyalgia and i can’t walk or stand very long i hurt all the time i can’t funtion alone i also have diabetes and asthma real bad i wish i could do the things i used to doi have gained alot of weight because i can’t walk or do anything some people think i’m just lazy but walk one day in my shoes i don’t wish this on my worst enemy and i would give anything if i could just walk with out having to sit every 10 feet and gasp for breath at least then i could do something for my self i would live with the pain if i could walk pain is my life and i am useless

  19. James Hubbard, M.D., M.P.H. Says:

    Sharlene, I am so sorry to hear that. I wish I could help. I am assuming you have a doctor who has evaluated you, made the diagnosis and treats you and have tried these things, but just to make sure.
    -Exercise. Have you tried water aerobics? As you may know, exercise is very effective treatment.
    -Medicine. Have you tried tricyclic antidepressants? Not for the depression,
    but for the treatment of the fibromyalgia. A recent study shows they can
    help considerably.
    -If you have a good multifaceted, pain clinic in town, it could be of great benefit. I am talking about one that offers medicication, counseling, physical therapy, procedures, etc.

    Talk to your doctor about taking small steps every day that could lead to considerable gains, with time.

    thanks for taking time to comment.

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