Calling for greater fibromyalgia awareness among doctors

The syndrome fibromyalgia is still relatively unknown to many doctors. This week arranged Norwegian Rheumatism, Norway Fibromyalgia Association, NTNU and the Norwegian Center service for rheumatology rehabilitation a seminar in fibromyalgia titled “Fibromyalgia and chronic pain – better diagnostics, treatment and rehabilitation.” The seminar had financial support from the Research Council.

– It is very gratifying with support from the Research Council, for it shows that they now want to pursue this, says Egil Fors, pain researcher and professor of family medicine at the Department of Community Medicine and Nursing at NTNU, who also initiated the seminar

Disturbance of the central nervous system
Facing Today’s Medicine explains Fors that in research on fibromyalgia has gone from believing that the condition arose as a result of a primary inflammation, disease or injury in muscle or bone, to determine that the cause is more complex.

– Recent research shows that fibromyalgia now being considered to be a disorder of the central nervous system sensitivity, so-called central sensitivity, and regulation of pain, more than one muscle. Fibromyalgia is considered not longer as a diagnosis of exclusion, but may be present along with other diseases and conditions, he explains.

Professor Daniel Clauw (right) at the University of Michigan and Professor Winfried Häuser at the Technical University of Munich lectured at the seminar.
Photo: Vilde Baugstø

Thus, scientists might one step closer to understanding more of this pain syndrome, where those who are afflicted with chronic and widespread pain – in addition to several other symptoms. Precisely because the symptoms are so complex, it has also been difficult to diagnose fibromyalgia.

Egil Fors explains the name fibromyalgia is also under debate, and it has been launched alternative terms’ central sensitiviseringssyndrom, “” fibromyalgianess “or” primary pain. ”

Changed criteria
As the sight of fibromyalgia has changed, it has also changed the criteria for diagnosis.

– Now operates with six symptom criteria in addition to muscle pain in both sides of the body. The symptoms are fatigue that may resemble ME, difficulty concentrating and memory problems, that they sleep badly – many with fibromyalgia feel exhausted when they wake up, depressive symptoms, irritable bowel symptoms and headaches, says Fors.

The patient is then measured on the six symptom criteria in a scoring system, before you put together these with the widespread muscle pain similar to make a diagnosis.

– An important change with the new fibromyalgia criteria in relation to the old with the examination of the pressure points, is that you can now quantify fibromyalgia on a continuous scale, says Fors, but emphasizes that it is not in the researchers’ intention to push new diseases in people and cause medicalization.

– However, if doctors can easily understand that the patient may have fibromyalgia, so it is also easier to tailor a good treatment, he points out.

Different treatment
During fibromyalgia seminar also attended the two world-renowned professors Daniel J. Clauw and Winfried Häuser, respectively head of CPFRC – a world-leading research with a focus on identifying effective mechanisms for chronic pain and fatigue syndrome at the University of Michigan, and clinical consultant in psykosomatisk- and pain medicine at the ambulatory health center in Saarbruecken St. Johann and researcher at the University of Munich.

The two professors had different approaches to the treatment of fibromyalgia patients.

– I think the primary purpose of the treatment should not be to reduce the pain, but to make the quality of life and the daily function of the patient better, said Winfried Häuser during the seminar.

Because fibromyalgia may be several reasons and because patients experiencing symptoms to varying degrees, it is also important to adapt the treatment individually, he pointed out.

– Some patients have major sleep problems or a lot of pain, and then it may be appropriate medication. Others have problems with the psychological, and then we need to provide another treatment, said Häuser, and also stressed that the treatment must also be tailored according to how hard the patient is afflicted.

Häusser pointed out that according to the research that has aerobic exercise demonstrated good efficacy in the treatment of patients with fibromyalgia.

– Psychological treatment and treatment of physical activity takes longer and can be difficult, but in the longer term it will be more effective than treatment with medications, said Häuser.

Higher risk in individual groups
His US counterpart Daniel Clauw was not disagree with Häuser in the choice of treatment, but pointed out that they had a different approach in the United States.

– Often the patient must have medication before she can participate in the cognitive therapy or do physical activity, because she is so hard hit. It is also important to remember that when comparing studies on drugs with studies on non-medical care, they will always non-medical care to get the best out because they do not have any placebo effect comparing with said Clauw.

Egil Fors explains that although researchers do not exactly know why fibromyalgia occurs, so they know that some groups have a higher risk of fibromyalgia than others.

– Often, there are other pain conditions or psychological stresses that post-traumatic stress syndrome or other that allows the body is on red alert. If there is a genetic vulnerability in the bottom is not yet clarified, but it is likely, says Fors and adds:

– Studies of veterans shows that many have fibromyalgia-like symptoms.

Enlighten doctors
Fibromyalgia is often referred to as a “mysterious” condition, as patients find that they have to go on for many years before they are diagnosed. Earlier there were many doctors who said bluntly that they did not believe in the state. Enlarge mean if more doctors are becoming aware that the syndrome is due to increased sensitivity and dysregulation of the nervous system, then there will also be more attention and understanding about how to treat and deal with it.

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