Fibromyalgia - page 3

What are your opinions, nurses? Is Fibromyalgia a justified condition or just a basket term ? I am interested in your feedback. It seems like we see a large number of patients (usually women) with... Read More

  1. by   vwgirl
    Quote from CCU NRS
    Is this a new qualifier, I was under the impression that FM was basically Dx'd by R/O everything else?

    I know that many people seem to have a Dx of depression first and C/O unrelenting/undefinded abd. pain that is only alleviated by narcs and these same people have usually been R/O for every possible GI ailment.

    There is often a large correlation between abd. disorders and depression, IBS, reflux, etc. with these the chicken and egg theory has often been applied.

    I personally tend to see FM Dx's when nothing will help with pain except narcotic intervention. Is this because there is FM or because there is no real problem except a need for narcs?

    The 18 tender points are the diagnostic qualification used by the American Academy of Rheumatology, which is the subspecialty that treats fibro patients. My friend who has fibro is a recovering drug addict with 15 years clean; her fribo did not manifest itself until she had over 8 years free of drugs and alcohol. But I do suspect that all the toxins she ingested over the years of active addiction could have blown her immune system. The research I did for my paper pointed strongly towards and autoimmune response being responsible for this disease. BTW, there is still no "definitive" answer as to what causes depression, which is finally recognized as a legitimate disorder. Just because we don't have all the answers doesn't mean we need to blow off that possibility that a disease process exists, painfull and debilitating.
  2. by   teeituptom
    My sister who I love has been Dxed with FM
    they have her on so many meds from antidepressants to narcotics. And she is a nurse.

    But if she was a nurse here in Texas I would myself turn her into the BNE as an inpaired nurse.
  3. by   ScarlettRN
    about oh, 7 years ago, I had two separate anaphylactic reactions to first naproxin sodium and then to motrin. This has devistated me, because I had lived on motrin for years to take care of my endometriosis. In 99, I hurt my back and it just didn't get better. I had to take lortab as the lowest level pain reliever after regular tylenol. Between the endometriosis and the lbp, I could not catch a break. My doctor sent me to a "pain doctor" later the same year I got hurt and there I stayed, personally restricting how much narcotic was prescribed and more than once refusing oxycontin from him. Fast forward to last summer. After 5 abdominal surgeries in 2 years, I learned two things about my body. First, my pelvis was so twisted out of alignment my GP came into the room after seeing an actual X-ray of my back and pelvis,(first one in about 4 years) and asked me if my back always hurt. (duh) The second thing I learned was that there was so much scar tissue in my abdomen and it was wrapped around my bowel in the same general area as my back pain, that once the scar tissue was removed, the pain in my back lessened to a degree. It was this past summer that the pain doc told me I probably would not get better and called it FM for the first time. I sat down with one of the ER docs I trust and when I found out what FM was, I REFUSED TO ACCEPT the diagnosis. My insurance was not going to pay for it, so out of pocket I started going to a physical therapist who specializes in chronic pain. After a solid month of PT, we got my pelvis moved back where it needed to be, and all of a sudden, I didn't hurt any more.
    The conclusion of this is that *I* had control over my health, ultimately. I was depressed about the pain and it was a viscious cycle that, once it was pointed out to me and I was sick enough of the way I was living, I got aggressive and dealt with it.
    I still get back pain after working, but it isn't crippling. I am going to stay on antidepressants until I have been free of the chronic back pain for one year, then I will be FREE!!!!
    Last edit by ScarlettRN on Mar 25, '04
  4. by   sbic56
    Quote from vwgirl
    Fibro patients classically have "non-restorative sleep"; they rarely get into the deep sleep stage, no matter how tired they are. The diagnostic criteria for fibro as far as the aches and pains go are defined by 18 tender points that must be painful upon palpation with 4 kg of force. Just having regular ol' "muscle aches" after a hard day doesn't do it for a diagnosis.
    Hmmm...do you know if this sleep pattern disturbance is also the case with Chronc Fatigue Syndrome? Just wondering, as this too, is a newer phenomena. I have wondered if the source of these "new diseases" is environmental.
  5. by   nursedaisy
    Can you feel your patients pain? No, then why are so many on here quick to judge. Just because you may have had bad experiences with some doesn't mean that all patients dx with FM are hypochondriacs or on anti depress. or pain meds. I though we were suppose to have empathy toward our patients? How can you show concern and empathize with someone comming into your ER or wherever that you have already formed a bias opinion about.
  6. by   teeituptom
    Quote from ScarlettRN
    about oh, 7 years ago, I had two separate anaphylactic reactions to first naproxin sodium and then to motrin. This has devistated me, because I had lived on motrin for years to take care of my endometriosis. In 99, I hurt my back and it just didn't get better. I had to take lortab as the lowest level pain reliever after regular tylenol. Between the endometriosis and the lbp, I could not catch a break. My doctor sent me to a "pain doctor" later the same year I got hurt and there I stayed, personally restricting how much narcotic was prescribed and more than once refusing oxycontin from him. Fast forward to last summer. After 5 abdominal surgeries in 2 years, I learned two things about my body. First, my pelvis was so twisted out of alignment my GP came into the room after seeing an actual X-ray of my back and pelvis,(first one in about 4 years) and asked me if my back always hurt. (duh) The second thing I learned was that there was so much scar tissue in my abdomen and it was wrapped around my bowel in the same general area as my back pain, that once the scar tissue was removed, the pain in my back lessened to a degree. It was this past summer that the pain doc told me I probably would not get better and called it FM for the first time. I sat down with one of the ER docs I trust and when I found out what FM was, I REFUSED TO ACCEPT the diagnosis. My insurance was not going to pay for it, so out of pocket I started going to a physical therapist who specializes in chronic pain. After a solid month of PT, we got my pelvis moved back where it needed to be, and all of a sudden, I didn't hurt any more.
    The conclusion of this is that *I* had control over my health, ultimately. I was depressed about the pain and it was a viscious cycle that, once it was pointed out to me and I was sick enough of the way I was living, I got aggressive and dealt with it.
    I still get back pain after working, but it isn't crippling. I am going to stay on antidepressants until I have been free of the chronic back pain for one year, then I will be FREE!!!!
    Hang in there Scarlette
    I will pray for your success
    I like your drive
  7. by   teeituptom
    Quote from nursedaisy
    Can you feel your patients pain? No, then why are so many on here quick to judge. Just because you may have had bad experiences with some doesn't mean that all patients dx with FM are hypochondriacs or on anti depress. or pain meds. I though we were suppose to have empathy toward our patients? How can you show concern and empathize with someone comming into your ER or wherever that you have already formed a bias opinion about.
    Its easy Nursedaisy
    while those who come in with their FM
    I just realize that it is going to take higher doses of narcotics to get them home.
    Inwardly I may raise and eyebrow or roll my eyes at some of their antics I have seen some use to manipulate in the ER.And I have seen some Drama Queens types who come in with it. I just give them whatever the MD orders. And I smile.

    I have dealt with and listened to my sister
    I still love her, but guess what she isnt making any attempt to help her situation.. And she drives a car while under the influence of these meds, scares me
  8. by   nicki2
    Quote from silkybo
    everyone i know with fibromyalgia is a. a hypochondriac b. clinically depressed or c. a drug seeker. i dont believe in this diagnosis. throwing oxycontin at aches and pains is like killing mosquitos with a sledgehammer. i am not against appropriate pain meds, especially in the terminal patient....dose 'em up, i say, but not for people who are just not facing life square on...i hurt too after lifting obese geriatrics all night, but im not going to whine for narcs!
    i have been diagnosed with fm for over 10 years.

    a. i am not a hypochondriac b. i am not depressed...i am very happy c. i do not take any pain meds. i have learned to deal with my pain. it is not the same as simple aches and pains...i wish that was all it was...but if one sits and stays in bed, wallows in self-pity...then yes they will feel greater pain and be depressed.

    to those of you that have fm, i say, "get out of bed and off the couch and go to work!" it may hurt like heck, but you will feel worse if you do not move. in addition, "stay off the sleeping meds and narcotics!"

    so silybo...there are some of us with fm that have never visited an er for pain control for fm and do not plan to do so in the future. do not lump all of into the same basket. it is a real shame to read how so many nurses have lost their compassion, because of a few frequent fliers.
  9. by   dianah
    It is also a shame, though, on the flip side, to see how many people attempt to manipulate the system with that (or another) diagnosis. Their behaviour certainly colors the outlook of those caregivers who come in contact with them (and they're probably more frequently in contact with the healthcare system than legitimate FM sufferers). So it is understandable that ER personnel would have, shall we say, a jaundiced opinion of the FM diagnosis. I just wanted to submit my two cents in support of true FM patients, who have enough to endure without experiencing labeling by health care workers. Peace to all, and courage to you great ER nurses (I could NEVER work ER, I know this) and FM sufferers. I promise not to hijack this thread again. -- D
  10. by   veetach
    I try to remain very empathetic to anyone who is experiencing pain. I dont doubt that the majority of these people are having pain. I am just not quite sure that I buy the diagnosis. Is it a basket term? Are there diagnostic tests to rule out/diagnose this condition? Is it something that stands alone or does it always accompany other disorders? (ie. depression, chronic fatigue)


    Also, why did it just surface in the 80's? what did we have in the 80's that we didnt have in the 70's to enable us to diagnose people with this condition? How is it that I see people with Rheumatoid Arthritis who seem to be more physically fit than some with FM? I am just trying to find some answers. I certainly have no intention to offend anyone, and If I have with this thread I apologize.
  11. by   RNin92
    I think FM is definitely in the auto-immune disorder class.
    Unfortunately, these disorders are poorly understood...but real nonetheless.
    FM will probably turn out to be several as yet undetermined diagnoses that are related.

    Serotonin is a factor...hence the anti-depressants. But check dosages next time...usually they are far less than those who are on anti-depressants for clinical depression. Same goes for sleepers.

    My little bit of input comes from my daughter at age 16 being mis-diagnosed several years ago...with FM being the first of many wrong Dx. Then Lupus...finally the REAL diagnosis Arthritis-also auto-immune in nature.

    When we first were told FM...we researched a great deal...all very disheartening. So many people are terrified to let anyone know their Dx...

    If anyone out there has read any of my posts then you know how LITTLE sympathy I have for FF...but that is because of their misuse of the healthcare system...not because of thier chronic pain state. True sufferers can have anything that will help from me.

    I think the FF that WE see that say it is their FM are just as much seekers as those that come in with their chronic back pain, or abdominal pain, or migraine, or whatever...it's the behavior not the "diagnosis".

    People who are routinely in the ED more often than the nurses are mis-using. Period.

    I, too, have migraines and chronic back pain. I work full-time. Take care of my family. See my doctor when I need to. I don't take narcotics. I try to be careful. Some days I am better than others. I am responsible for my health and my healthcare.
    Last edit by RNin92 on Mar 27, '04
  12. by   RNin92
    Sorry...didn't mean to rant.

    I'll climb down from the soap box now.

  13. by   Nightcrawler
    I have suffered from FM since I was 18. I am 34 now. Through my research and personal experience i have found that narcotics do not work. Sometimes muscle relaxants help, but not all of the time. I have tried narcotics in the past, and 1. I don't like how they make me feel, and 2. I can often still feel the pain.

    What I have found that does work is, in order of importance, stress reduction, a good nights sleep, light massage, and anti-inflammatories.

    I suffered for years without knowing what was wrong. My friends and family thought that I was the biggest whiner in the world. I questioned my own sanity as time as I struggled with the pain and sleeplessness. I suffered the attitudes of health professionals such as many of you who assumed that I was drug seeking when I was merely searching for an answer, and I had two separate doctors try to declare me disabled at the age of 20!!!!

    I was finally lucky enough to find a doctor who could tell me what was wrong. Just having a name for what I was going through was a enormous relief. I wasn't crazy. There was something that I could research and try to understand. The diagnosis did not cure me, it was only the start of the journey, but it gave me hope.

    I see patients abuse pain medication and drug-seek all the time that have tried and true, traditional, and medically verifiable illnesses. I still treat them. I try not to judge these patients, and I try not to judge those with FM that are still on their own journey to find a level of pain that they can live with

close