Yesterday I attended a lecture by the most popular rhumatologist in town. The doctor was presenting on fibromyalgia and osteoporosis. In a community like Lake Havasu City, a popular snowbird roosting spot, these are two conditions shared by many. He described fibromyalgia taking delight and pride in the fact that it was recognized by the AMA in 1987 and received drug prescription approval by the FDA in 1997. So now people are given a name and a drug if they can prove “ membership” in the fibromyalgia club (as described by the physicians.)
The presentation included a chart graphing the most popular new drug, as it was tested against a stronger version of the same drug, and against a placebo. What I saw were three lines, descending in roughly the same pattern down the pain scale. Our doctor told us that because the two versions of the same drug had insignificant differences that the milder form was recommended. I raised my hand and asked, “But doctor, isn’t the line that represents the placebo in just about the same pattern and distance between as the other two drug lines?”
Instead of answering my question, he proceeded to describe the placebo effect and its history, leaving me still wondering why, if the difference between the two drugs was not considered significant, the same small difference between placebo and drug was the justification for prescribing this new “wonder” drug (which by the way, as you might guess, is very expensive).
The presentation continued to detail the prescription and traced the history of other, less effective drugs which were now being discarded in favor of this latest breakthrough. When the talk began to wind down, I raised my hand again. “ Are you going to talk about some non-pharmacological treatments for fibromyalgia, such as exercise, stress reduction, counseling, massage, physical therapy, yoga, water exercise, and diet?”
“No” was the curt reply, and the session was open to questions, all of which were related to prescription names and labels and comparisons of dosages.
Later on the same day, I was reading my latest Prevention magazine and came across a study, done in a hospital in Boston, with 135 women fibromyalgia sufferers. The protocol involved strength training, stretching, and aerobic exercise combined in a single exercise program. The vast majority of participants reported that this program, which lasted for 16 weeks, alleviated chronic pain symptoms, and that they experienced physical and mental improvements that had not diminished 6 months later.
So what to make of this? How to interpret the fact that there are at least two options for those who suffer from fibromyalgia: one an expensive drug, which admittedly has side effects and may have long term effects that have not been discovered yet, and the other, a simple program of exercise, designed to improve strength, flexibility, cardiovascular fitness and reduce stress, the side effects of which include; increased energy, decrease in body fat, improvement of daily living skills, alleviation of depression, and a more positive attitude towards life.
I leave you to draw your own conclusions. If given the option for your own treatment, which would you choose, and/or which are you choosing right now?
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lynn difley
Hi all, thanks so much for not only reading but responding to my blog. I owe you an apology Jane, and thanks for correcting me. I did not mean to suggest that we have an either or situation when it comes to pain management. I was reacting to the lecture that I attended, in high hopes, and my disappointment that the doctor did not “have time” to discuss any alternatives other than drugs. As the others pointed out, it takes a combination of treatment modalities to get a handle on this condition. We are now trying to improve our water exercise program which has had good results. A good cardiovascular workout improves sleep patterns for many of the students. However, a small group feel the water temperature, at 86 is too cool and prefer the warmer therapeutic pool. Others say the warmer pool is too hot, causing them to feel dizzy and increasing the pain they feel after exertion. I have no definite answer, as it is often an individual matter, heat or cold, exertion or relaxation, strengthening or stretching, drugs or meditation, and I have great admiration for each and every one of my students who struggle with their pain and continue to experiment and try new modalities until they find a “prescription” that works.
Lucille
I agree with Jane in that a combination of medication for pain and sleep, massage, and stretching exercises have worked best for me. Also learning how to change your lifestyle. I limit the time spent vacuuming, gardening, etc., to 20 – 30 minutes and then change to something else. To Dave: I was on amitriptyline for several years but have changed to nortriptyline, a newer “drug” and have fewer side effects and more energy.
Dave B.
Jane. I sense that biting you would only inflict more pain than you are already experiencing. But I’m with you. My wife has had fibromyalagia for years and was diagnosed when very little was known about this form of arthritis. You describe it as a pain disorder but it is officially a sleep disorder which induces the pain as REM sleep is not achieved in a normal fashion. My wife has been taking amytriptalene (spelling?) for several years with very good results. There are some side effects but bearable when compared to the relief. I have sympathy for anyone with this disorder. It’s hard enough to exercise when you are not in pain let alone when you are. God love you.
Paul
Having spent 30 years with a spouse who went from self-motivated, daily exercising, self-employed entepreneur to a semi-invalid, I’m with Jane on this one. Difly seems to have contracted that flu-like wisdom that so many-but not all-doctors have these days: the knowledge that in their academic experience with a subject they have learned all that’s necessary to know they’re right and that others are foolish, and that you really just need to try harder.
Jane
Which do I choose? Are you kidding? Is this a trick question? I choose both, and here’s why. Fibromyalgia is a pain disorder. Like all pain disorders, it can be *managed* by conservative treatments such as yoga, wet heat, etc (many of which I also utilize, including daily yoga and meditation). It can be alleviated, however, by both conservative AND pharmacological means. For me, a tramadol regimen, in conjunction with the conservative measures, relieves my pain as well as helps me manage the disorder. This combination gives me the highest quality of life and functionality.
It’s a false dichotomy, and I’m fed up with the suggestion that those of us on medication are taking some “easy” way out. I tried conservative measures only approach for five freaking years without substantial relief, before I finally “gave in” and tried medication, which saved my life.
So Fred and Leo? Bite me, with all due affection.
Fred
Good blog today. Doctors today are nothing but legal drug pushers of basically unnecessary medications that are marketed on TV to a gullible, lazy audience.
Leo
I think this is easy to figure out. One option requires opening your mouth and swallowing. The other involves the expenditure of energy (sometimes referred to as exercise) in several forms. The former will all ways be preferable to most or is this just being too cynical ?