USA
From the April 2008 issue of The Fibromyalgia Network Newsletter: This article was written by Dr. Glenn A. McCain a fellow of the American College of
Rheumatology and Fellow of the Royal College of Physicians of Canada who practices rheumatology and internal medicine in Charlotte, NC:
"The greatest achievements are the cumulative events over the last years that show patients with FM do indeed suffer from demonstrable 'organic' pathology. What is key is that studies pointing to this conclusion were accomplished by reputable academic physicians using the principles of the scientific method. The three most telling of these are:
1. Jon Russel, M.D., Ph.D seminal finding of altered concentrations of pain neurotransmitters in FM cerebrospinal fluid.
2. Leslie Crofford, M.D., finding that blocking voltage gated calcium channels with pregabalin leads to a reduction in perceived pain/tenderness.
3. Robert Bennett, M.D., intervention with growth hromone showing a reduction in clinical slympotms and allodynia (FM pain).
These findings alone support the idea that there is at play both a 'central' and 'peripheral' nervous sytem abnormality in FM. Thses studies were carefully done and should lead an open-minded physician to conclude that there must surely be a physiological basis for this clinical syndrome such that it can now be called a DISEASE. These studies support the patient assertion: 'Fibromyaliga is a real pain.'
The major roadblock continues to be the bias against FM held by many respected academic and front line physicians. The recent Rheumatology Board Examination for example had only two questions concerning FM- despite the fact tha fibromyalgia constinutes about 25 percent of most community rheumatology practices.
There were no quesitons on pain, pain mechanisms, or pain pharmacology let alone even simple interrogation on the principles of pain behavior. There is a good reason for this. Fibromyalgia is taught well in only a few academic centers. The skills needed to treat FM patients well encompass the fields of pain pharmacology and psychology as well as pain rehabilitation.
Learning these skills requires the physician step beyond his training to develop them- aprocess that may be uncomfortable and difficult. All rheumatologists who see fibromyalgia in their clinics face a terrible dilemma. Do I have the skills to treat these suffering patients well and help make them better? The logical conclusion for those physicians who do not, is to rebel at the idea (and yes the very existence ) of fibromyalgia, feeling that they did not sign on for such a job.
'This surely must be some other person's (subspecialty) responsibility.' Even if they feel some poverty of thought at this conclusion there is no ready remedy at hand in their communities. It is much easier to rebel than to learn.
I am reminded of am Alma Mater and her motto: 'Knowledge Grows Like a Tree.' It needs the fertilizer of new ideas. Hopefully a stout band of academic and front line rheumatologists will continue the hard digging."
All I can say is those of us with fibromyalgia certainly did not sign up for this job either so these doctors need to get off their butts and start learning and reading the research rather than talking out their butts instead of their brains!
sue in ohio
"The greatest achievements are the cumulative events over the last years that show patients with FM do indeed suffer from demonstrable 'organic' pathology. What is key is that studies pointing to this conclusion were accomplished by reputable academic physicians using the principles of the scientific method. The three most telling of these are:
1. Jon Russel, M.D., Ph.D seminal finding of altered concentrations of pain neurotransmitters in FM cerebrospinal fluid.
2. Leslie Crofford, M.D., finding that blocking voltage gated calcium channels with pregabalin leads to a reduction in perceived pain/tenderness.
3. Robert Bennett, M.D., intervention with growth hromone showing a reduction in clinical slympotms and allodynia (FM pain).
These findings alone support the idea that there is at play both a 'central' and 'peripheral' nervous sytem abnormality in FM. Thses studies were carefully done and should lead an open-minded physician to conclude that there must surely be a physiological basis for this clinical syndrome such that it can now be called a DISEASE. These studies support the patient assertion: 'Fibromyaliga is a real pain.'
The major roadblock continues to be the bias against FM held by many respected academic and front line physicians. The recent Rheumatology Board Examination for example had only two questions concerning FM- despite the fact tha fibromyalgia constinutes about 25 percent of most community rheumatology practices.
There were no quesitons on pain, pain mechanisms, or pain pharmacology let alone even simple interrogation on the principles of pain behavior. There is a good reason for this. Fibromyalgia is taught well in only a few academic centers. The skills needed to treat FM patients well encompass the fields of pain pharmacology and psychology as well as pain rehabilitation.
Learning these skills requires the physician step beyond his training to develop them- aprocess that may be uncomfortable and difficult. All rheumatologists who see fibromyalgia in their clinics face a terrible dilemma. Do I have the skills to treat these suffering patients well and help make them better? The logical conclusion for those physicians who do not, is to rebel at the idea (and yes the very existence ) of fibromyalgia, feeling that they did not sign on for such a job.
'This surely must be some other person's (subspecialty) responsibility.' Even if they feel some poverty of thought at this conclusion there is no ready remedy at hand in their communities. It is much easier to rebel than to learn.
I am reminded of am Alma Mater and her motto: 'Knowledge Grows Like a Tree.' It needs the fertilizer of new ideas. Hopefully a stout band of academic and front line rheumatologists will continue the hard digging."
All I can say is those of us with fibromyalgia certainly did not sign up for this job either so these doctors need to get off their butts and start learning and reading the research rather than talking out their butts instead of their brains!
sue in ohio
Jilly
California US
Mosken
