I Have Offended Someone…

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Normally in these situations I’m tempted to tell someone to pull up their big girl panties and deal with it, or accuse them of being humor-impaired, but in this case I’ll refrain from calling a waaaambulance and address the offended party with tact and reason.

Yeah, I know. Not my strong suits.

Tbeck was somewhat offended by my post making fun of fibromyalgia:

I know an LPN that has the condition. My WIFE also has the condition. There is no doubt in their minds that it is real. Like others, she manages to live a fairly normal life with OTC medication as her primary source of pain mitigation. She is not a junkie and has worked hard not to become one. The temptation to go with something stronger is tremendous but she resists it because she has seen where that road will inevitably lead.

Anecdote does not equal evidence. Their certainty of the diagnosis simply amounts to two opinions. Now keep in mind, I’m not discounting their opinions, but that’s all they are. For that matter, the physician who diagnosed them with fibromyalgia is also offering an opinion disguised as a diagnosis.

The problem is, fibromylagia and other nebulous disorders such as chronic fatigue syndrome are diagnoses of exclusion – conclusions reached in the absence of any reliable evidence pointing to another identifiable disorder. In layman’s terms, it means “I can’t find anything wrong with you but your symptoms seem real enough so we’ll make up a name to call it.”

Your post was uncalled for. It’s hard enough to get a good diagnosis without the doctor’s own preconceptions and stereotypes getting in the way. The doctor rolling his eyes is the problem, not the solution.

No, the person coming in to the ER or calling an ambulance at 3 am for their fibromyalgia symptoms is the problem. Even accepting your premise that fibromyalgia is a legitimate disorder, coming to the ER seeking narcotics is neither appropriate management of the symptoms nor appropriate utilization of emergency services. My post was poking fun at the people who abuse emergency services using fibromylagia as their excuse, not at any specific person or disease process. Perhaps the distinction was lost on you.

Most people who come to the ER with fibromyalgia complaints exhibit none of the signs of being in pain. While I know that pain is subjective, physical discomfort produces certain physiological responses. Your adrenal glands secrete catecholamines (epinephrine, norepinehrine and the like) which activate your fight-or-flight response. Pupils dilate, heart rate, breathing and blood pressure all elevate. You sweat. You get anxious, fidgety and restless. You may even get a little queasy.

All of these things can be physically observed. But when someone tells me they have fibromyalgia and rates their pain as a 10, all while chatting calmly on their cell phone with a blood pressure of 110/70 and a heart rate of 64, and they just happen to be allergic to Tylenol, Motrin, Toradol, Ultram, Naprosyn and aspirin, I reserve the right to call bullshit. Any medical provider with a functioning synapse would do the same.

Interestingly enough, all of those symptoms I mentioned also scream “narcotics withdrawal.” Guess what? If there is any doubt in my mind, I give the pain meds. I’ll give sedatives to the withdrawal patients, too. Withdrawal is unpleasant. Heck, I give so many analgesics compared to my EMS co-workers that I’ve been called The Candy Man. If you read some of my old posts, you’ll find that I’m a strong proponent of aggressive pain management.

In any case, I applaud your wife’s ability to manage her symptoms without narcotics or frequent ER visits. If she’s not already doing it, tell her that regular physical exercise also appears to alleviate the symptoms dramatically. Whether there is a physiological reason for this, or whether the relief is purely psychosomatic from endorphin release, has yet to be established. In any case, the people I know who claim to have fibromyalgia swear by regular exercise.

Telling someone who cannot get a good night’s sleep and lives with chronic pain that “it’s all in their head” is right up there with ridiculing the germ theory of disease because you can’t see the critters with a naked eye.

Specious argument, Tbeck. The fact is, medical science has found NO causation for fibromyalgia. No one knows what causes it. No one knows what cures it. It’s a set of symptoms desperately searching for a disease.

And the ugly truth is, it actually may be all in their heads. Don’t be so quick to discount a psychiatric cause. Saying so doesn’t make the sufferer crazy, and should bear no stigma. It doesn’t even mean their symptoms aren’t real. It just means there is no identifiable physical cause for the disorder.

Frankly, until there is legitimate scientific study that discovers a causative relationship between fibromyalgia and an identifiable, measurable factor, we will neither have an accurate diagnostic test for it, nor a viable treatment.

Until that day, it remains the province of charlatans and shamans, and lazy doctors all too willing to give you a catchall diagnosis as a panacea for your problems. What masquerades as “proof” of fibromyalgia is merely a collection of junk science, anecdote and questionable testimonials. People who advertise “cures” for fibromyalgia are unconscionable snake oil salesmen preying on the gullible.

Using your analogy, the current “research” supporting the existence of fibromyalgia is the 21st century equivalent of belief in the homunculus.

Anyhoo, thanks for your comments and your readership. When or if the day comes that science actually legitimizes fibromyalgia, I look forward to continuing the debate with you here and eating my words.

If that happens, bring some Tabasco, would ya? I hate bland words.