Hello, everyone, this is Dr. Warren. It has been a while since I last posted but I’ve been busy updating systems at the clinic to help everything run a little smoother this spring/summer. I’ve had a slew of fibromyalgia patients so I figured it was a good topic to write about.
If you are wondering if you have fibro, the triad of symptoms I look for is chronic pains moving throughout your body (usually in multiple joints), fatigue, and difficulty sleeping.
If you are new to my blog you’ll find I am absolutely obsessed with how things work and why things happen. If you have fibromyalgia I will want to know why you have it or what causes it. If you are on a drug or vitamin I want to know how (the method) it works.
The Trash Diagnosis:
I’m going to start by being blunt. Fibromyalgia is a waste basket diagnosis. When a doctor diagnosis you with fibromyalgia, it means you hurt all over and they can’t figure out why! It does not tell the cause. It does not say why you hurt all over. It is simply a diagnosis that acknowledges the doctor confirms you complain of hurting all over.
My conversation usually goes like this with a new fibromyalgia patient:
Me: “Do you know why you hurt all over and struggle with chronic pain?”
Patient: “I have fibromyalgia.”
Me: “Yes, but what is causing the fibromyalgia? How does the fibromyalgia cause pain in your body?”
Patient: “I don’t know. No one has ever asked what is causing the fibromyalgia.”
This is such an important question! What is the cause of the pain? Let’s take a brief look at common drug strategies for fibromyalgia and the mechanisms for how they work. Theoretically, we can figure out how fibromyalgia causes pain if we understand how the treatments work.
Common drug strategies for patients with Fibromyalgia:
- Anti-depressants usually an SSRI like Cymbalta: This is typically first line medication strategy for fibro. These drugs help increase serotonin and nerve signaling. The thinking here is that fibro is a result of depression and poor sleep. This isn’t a bad theory, it is just incomplete. Anti-depressants are also typically the first thing a doctor reaches for with a patient struggling with any chronic health problem the doctor doesn’t understand. So many of my fibro patients feel like they get anti-depressants thrown at them because the doctor just thinks they are making it all up. This is unfortunate.
- Painkillers (NSAIDs) like ibuprofen or naproxen:
a. These are anti-inflammatory medications for reducing pain. I think this drug is the closest thing we have to get at the root cause. This condition is highly linked to inflammation, but we’ll talk more about this later.
- Lyrica. Gabapentin/Neurontin:
Lyrica is now officially approved by the FDA for the treatment of fibromyalgia. With this approval, it is a very common drug for the fibromyalgia people to be on. The big question is how does this drug work. Is this helping the root cause of the disease or are we simply covering up the symptoms? Unfortunately, these drugs really just cover up the symptoms. They work by blocking nerve signals, so you do not feel the pain. I think this treatment is absolutely crazy in the long term! We solved a chronic pain problem by breaking the nerves that send the pain signals.
In conclusion, the treatments options for someone with fibromyalgia are currently inadequate. None of them really identify or address the cause of the disease.
The secret cause that should no longer be a secret
Invariably, when a patient walks in my door with fibromyalgia, I have one thing on my mind. “Where is the autoimmune disease?” Often this has been missed and they have no idea they have an autoimmune disease. Sometimes they know they have an autoimmune disease and it is absolutely not being handled correctly (We’ll talk about this in the next article).
To make a long story short, autoimmune diseases have been mismanaged and oversimplified in America for the past 50 years. The research showing they are something bigger is there, but we are fighting 50 years of wrong indoctrination about autoimmunity. We used to think autoimmune diseases were not related to each other, but that is wrong. We used to think autoimmune diseases were specific and only damaged part of the body with no global effects, but that is also wrong. We used to not be able to test for autoimmunity well, but luckily now we can!
The autoimmune test you need that you haven’t gotten
When I look through most of my patients’ records who have fibromyalgia most of them have not even been tested for any autoimmune disease! Some think they have had “comprehensive testing” when really they have had an ANA test and RF to test for lupus and rheumatoid arthritis. Don’t get me wrong, these are great tests but I believe in my office those two tests combined are around $30. That’s all the effort we went through to try to find a cause for the fibromyalgia patient? We spent $30 and called it “comprehensive testing”?
This is one of the uphill battles for fibro patients. Testing only ANA to check for autoimmune disease is a lackluster model of care from years gone by and patients deserve better.
The particular test that has been an eye opener for my fibro patients comes from cyrex labs and it is their panel 5. Array 5 is a “Multiple Autoimmune Reactivity Screen”. It is an awesome test for autoimmunity! This panel tests autoimmune reactions connective tissue, heart, muscle, adrenal, thyroid, intestines, joint, brain/neurological, pancreas.
This is so important for patients to know. If you have fibromyalgia, you are in pain, and we can identify you are autoimmune to your muscle and/or joints, that is so important! If you are autoimmune to parts of your nerves that is so important! It tells us why you have the fibro symptoms! It also points us in a direction to getting you better! If we can help your body regain control of the immune system and the autoimmune attack we can help your fibro right at the root cause!
We know beyond a shadow of a doubt that fibromyalgia people suffer from more autoimmune diseases than the regular public. A study from January 2007 Clinical Rheumatology entitled “The frequency of thyroid antibodies in fibromyalgia patients and their relationship with symptoms” found more thyroid and rheumatoid arthritis antibodies in fibromyalgia patients than controls. This study only looked at thyroid and rheumatoid arthritis, but if it were to be done on a broader autoimmune scale I am convinced it would show all fibro patients are autoimmune to something, the big question is simply “Where is their particular autoimmunity?”
Come back for article 2!
Thank you for reading. Be sure to come back for the 2nd article on fibro. I’ll cover some solutions for people with autoimmune diseases and show how various autoimmune diseases cause fibromyalgia in patients.