Understanding and Treating Fibromyalgia

Norman McCoomer, MD, on left, and program coordinator Roger McLain discuss a case during joint examination of a patient.

Fibromyalgia is a misunderstood condition that causes widespread pain and fatigue. A common misconception is that fibromyalgia isn't a real medical problem. But while much is still unknown about fibromyalgia, researchers have learned more in recent years.

Physicians and staff at the Alabama Fibromylgia Center in Huntsville have developed a comprehensive, multi-disciplinary approach to addressing the symptoms associated with fibromyalgia. As part of the Alabama Pain Clinic, this fibromyalgia center is one of only a few dedicated programs for treating the condition.

Recognizing the condition is the first step in treating these patients. “In people who have fibromyalgia, the brain and spinal cord process pain signals differently. They react more strongly to touch and pressure and have a heightened sensitivity to pain. It is a real physiological and neurochemical problem,” says Norman E. McCoomer, MD, MPH, medical director of the Alabama Fibromyalgia Center.  “While we look at fibromyalgia as a cluster of symptoms, we try to find the underlying reason for those symptoms in each patient.”

Roger McLain, CRNP, program coordinator for the center, says that fibromyalgia patients usually have more than just pain. “Many patients have trouble sleeping as well as de-conditioned muscles,” McLain says. “So in addition to management of medications, we provide assessments to diagnose and treat sleep disorders. We also offer behavioral health classes to help those who suffer from the condition to recognize some of the emotional factors that can trigger pain responses. Our physical therapists and nutritional counselors can also help patients learn healthier activities for daily living.”

The comprehensive approach at the Alabama Fibromyalgia Center is beneficial to both patients and clinic staff. “When you see specialists at separate clinics for the various problems associated with fibromyalgia, communication between those specialists regarding patient information may not always be consistent,” McLain says. “Our treatment team meets once a week and we share internal communication about each patient. That helps all of us stay on top of each case and enables us to track each patient’s progress consistently.”

McCoomer says the behavioral therapy helps both patients and their families better understand and manage the symptoms. “Once we understand a patient’s symptoms and what may be causing them, we give the patient a strategy to manage the pain. Often, these patients go through this illness with no point of reference,” he says. “Most people think there is a cure for every medical problem. It's frustrating to people with fibromyalgia because the traditional treatment approach isn't effective. And it's also frustrating to health care providers because we want to help people.”

McCoomer says the biggest challenge is teaching patients to cope with the pain. “These patients have been to so many doctors and haven’t seen any improvement in their symptoms,” he says. “We want them to understand that they must follow a treatment plan, but they want the problem to be fixed ‘now.’ But there is no easy fix. It takes lifestyle changes and small steps toward achieving wellness. It's a process.”

Primary care doctors often are at somewhat of a disadvantage in diagnosing the condition since there are no specific tests for a fibromyalgia diagnosis, McCoomer points out. He suggests that physicians do blood tests to make sure it's not something else like lupus, thyroid dysfunction, or rheumatoid arthritis. If the patient does not have one of these conditions but has the cluster of symptoms that make up fibromyalgia – specifically the 18 specific tender points that are the hallmark of the condition – the physician should refer the person to the Fibromyalgia Center.

"Patients often go to a lot of doctors trying to figure out what's wrong. The doctors may not be familiar with fibromyalgia so they don't necessarily know the diagnostic criteria for it -- and they don't necessarily check for it,” McCoomer says. “Through our in-depth evaluation and examination, we can identify the condition quickly and begin treating it. Our goal is to improve the patient’s quality of life. While we may not be able to eliminate the patients’ pain, we can help to relieve the worst of it. Many tell us that we help make their lives worth living.”



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