Fibromyalgia

[veetach]

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 "fibromyalgia" and the numbers are getting larger and larger.

I even had a patient tell me that fibromyalgia patients were predisposed to trigeminal neuralgia.

[ok2bout]

I dont doubt the pain is real to most of these pt's. However most of the ER doc's agree that many of these pt's were ones that were chronically seeing their FMD or utilizing the ER all the time and after extensive workups everything came back negative, so after awhile the MD's needed to make a dx and this is where many have been give the dx of fibromyalgia just for the sake of given them a dx. I work in a ER that treats close to 100,000 pts yearly and the number of people in the last year coming in with this dx is ever increasing. I have often heard that many times ER nurses doubt these pt's pain, and I have to be truthful, I am often one of those nurse's. One of the reasons is we often see the repeat pt week after week utilizing the ER for pain control....morphine and dilaudid....why are these people not being followed by their PCP?, and many times we find out these pt's have been utilizing the 2 other local hospitals and have been getting morphine and dilaudid. It's these type's of pts that abuse the ER that make ER nurse's a little skeptical of pt's coming to be seen for fibromyalgia. And unfortunately this is the case for any dx where pt's are abusing the ER and utilizing it for their primary care.

[dld, ASN, RN]

I dont doubt the pain is real to most of these pt's. However most of the ER doc's agree that many of these pt's were ones that were chronically seeing their FMD or utilizing the ER all the time and after extensive workups everything came back negative, so after awhile the MD's needed to make a dx and this is where many have been give the dx of fibromyalgia just for the sake of given them a dx. I work in a ER that treats close to 100,000 pts yearly and the number of people in the last year coming in with this dx is ever increasing. I have often heard that many times ER nurses doubt these pt's pain, and I have to be truthful, I am often one of those nurse's. One of the reasons is we often see the repeat pt week after week utilizing the ER for pain control....morphine and dilaudid....why are these people not being followed by their PCP?, and many times we find out these pt's have been utilizing the 2 other local hospitals and have been getting morphine and dilaudid. It's these type's of pts that abuse the ER that make ER nurse's a little skeptical of pt's coming to be seen for fibromyalgia. And unfortunately this is the case for any dx where pt's are abusing the ER and utilizing it for their primary care.

Yes those drug seekers are frustrating. But most people with FM are not like that. Just the ones you see! In my opinion pain pills just are not the proper way to treat central pain. It just creates the drug seekers you describe. I don't work in ER, but in Rehab, and sometimes, let me tell you, I think I am going to vomit if I have to ask one more time, "what is your pain level", when I know the answer will be 8-10, and the pt can barely stay awake. It is a very sad situation and frustrating to be a part of.

[dld, ASN, RN]

I dont doubt the pain is real to most of these pt's. However most of the ER doc's agree that many of these pt's were ones that were chronically seeing their FMD or utilizing the ER all the time and after extensive workups everything came back negative, so after awhile the MD's needed to make a dx and this is where many have been give the dx of fibromyalgia just for the sake of given them a dx. I work in a ER that treats close to 100,000 pts yearly and the number of people in the last year coming in with this dx is ever increasing. I have often heard that many times ER nurses doubt these pt's pain, and I have to be truthful, I am often one of those nurse's. One of the reasons is we often see the repeat pt week after week utilizing the ER for pain control....morphine and dilaudid....why are these people not being followed by their PCP?, and many times we find out these pt's have been utilizing the 2 other local hospitals and have been getting morphine and dilaudid. It's these type's of pts that abuse the ER that make ER nurse's a little skeptical of pt's coming to be seen for fibromyalgia. And unfortunately this is the case for any dx where pt's are abusing the ER and utilizing it for their primary care.

Yes those drug seekers are frustrating. But most people with FM are not like that. Just the ones you see! There are diagnosistic criteria for FM, and most MDs are not proficient in administering the pressure point test. So it often takes a Rheumatologist to make the dx. Unfortunately, other problems need to be r/o, often starting the long process of testing, without any treatment of the FM, and the condition just gets worse, and the pt's anxiety goes up. Any chronic condition treated in the ER is not properly managed. In my opinion pain pills just are not the proper way to treat central pain. It just creates the drug seekers you describe. I don't work in ER, but in Rehab, and sometimes, let me tell you, I think I am going to vomit if I have to ask one more time, "what is your pain level", when I know the answer will be 8-10, along with the sudden moans and groans, and the pt can barely stay awake. It is a very sad situation and frustrating to be a part of.

[catnip]

All i can say is OMG!!!!!! I have never seen so many nasty, rude, and short sighted posts in my life, sadly they far outweigh the post of those who are caring and compassionate and actually seem to care. I am in the process of going through the hoop jumping of tests, and have been told that most likely d/t the years of symptoms that I likely have FM. I have been a member of this site for some time now, and i found this thread in my search for information. I dont know wether to laugh or to cry. While i understand the frustration of FF's and the endless complaints of drug seekers that no one can please, in this day and age, how can so many people who obviously have education seem to be so hard hearted and uncaring. Perhaps burn out may play a role. If this dx is to be what i am given, does that mean that i should hang my head in shame and avoid the ER for fear of being labeled? Being a new nurse i know that there are many things it will take me years to understand, but the prejudice i have read here i doubt i will ever be able to justify. For every disease or condition that has ever been known to mankind there have been people who will use and abuse the system, no diagnosis is safe from this. For the sake of all current and future patients, please try to see beyond the dx and look at the person as a whole, you might just be amazed at what you find.

[ok2bout]

I dont think most people responding here are saying that all people with the dx of FM are drug seekers are that there pain is real. But when theses pt's are continuously utilizing the ER for pain control there definitely is going to be a red light that these pt's may be drug seekers especially when you see these pt's have insurance and could be managed outpatient.....pain centers and other specialty centers. Also there have been many times in my experience that some of these pt's come into our ER and do not disclose their complete medication list and then when we contact their PCP we find out they have been taking oxycodone, oxycontin, dilaudid, and some other heavy duty drugs that they just happened to forget they have been taking. Most pts' with real FM are being managed by their PCP's. The ER should be utilized in servere cases, such as when pt's are traveling, their PCP send's them to the ER, etc. FM should not be managed by several weekly visits to an ER. This is the case for any chronic illness and unfortunately many pt's with many chronic illness continue to use the ER as their PCP for these disease processes. I believe that most of the people responding on this web site are educated and compassion, but you also gain alot of experience after seeing these pt's over and over and you are able to make your judgements based on experience and history. My advice for you iCatnip is if your are dx with FM then have it managed outpatient, use the ER in emergencies, and try to get yourself as educated as you can about FM. I dont think were are labeling our pts drug seekers who have only had a few ER visits its the long term FF that we have to be a little more concerned with.

[I love my cat!]

Here is an EXCELLENT article regarding PAIN:

PAIN

Chronic pain seen altering how brain works By Julie Steenhuysen

Tue Feb 5, 5:50 PM ET

CHICAGO (Reuters) - Brain scans of people in chronic pain show a state of constant activity in areas that should be at rest, U.S. researchers said on Tuesday, a finding that could help explain why pain patients have higher rates of depression, anxiety and other disorders.

They said chronic pain seems to alter the way people process information that is unrelated to pain.

"It seems that enduring pain for a long time affects brain function in response to even minimally demanding attention tasks completely unrelated to pain," the researchers wrote in the Journal of Neuroscience.

To study this activity, Chialvo did a type of brain scan known as functional magnetic resonance imaging on 15 people with chronic back pain and 15 healthy people.

They gave their volunteers a simple attention task -- tracking a moving bar on a computer screen -- to observe the brain shifting out of default mode to handle the task.

Both groups performed the task well but when they measured areas of the brain activated, differences emerged.

EDITED

They said disruptions in this default network could explain why pain patients have problems with attention, sleep disturbances and even depression.

"These findings suggest that the brain of a chronic pain patient is not simply a healthy brain processing pain information but rather it is altered by the persistent pain in a manner reminiscent of other neurological conditions associated with cognitive impairments," they wrote.

(Editing by Maggie Fox and Bill Trott)

______________________________________________________________

Any educated and qualified Medical Professional will admit, we don't know A LOT about the brain! I find research and articles like this very encouraging!

[mmutk, BSN, RN, EMT-I]

I have edited to withhold my personal opinion

[Malanya]

I'm a long-term lurker, but this is my first post. I'd like to give a bit of background, and then ask a question that I hope won't be laughed at.

I'm 28 years old. I'm working in the computer industry while finishing my degree, hopefully to be a psych nurse (I couldn't handle an ER after being married to a resident who was in an ER rotation while waiting for an opening for OB-GYN.) At age 19, after my mother was dxed with FMS, she wanted me to go to her rheumatologist to investigate the muscle pain and poor sleep I'd had for years. Sure enough, with 13 of the 18 tender points, I was dxed with FMS as well. (Those ones at the point of the collarbone REALLY hurt.) I was given a ton of Flexeril, which just made me sleepy, and then given Zanaflex, which actually worked without making me horribly drowsy. But at that time, I was also very overweight, on BCP, and also on thyroid meds. After I was single, I quit the BCP and my weight dropped off almost as if my magic (scared my PCP actually). Losing the weight made a huge difference in my pain levels, as apparently I also have some disc issues and you know how weight loss helps those. Anyway, have not taken any meds for FMS for six years, and while I have an occasional bad spell they're not nearly as bad as they used to be.

I'm also allergic to aspirin and etodolac. (Also allergic to erythromycin, clindamycin, and a now apparently withdrawn quinolone called Raxar, but those are antibiotics.) Having five medication allergies, apparently, is a red flag for an ER. I've stopped mentioning the old FMS dx because it seems like every time I do I get really bad treatment from anywhere.

My question is this. I had to go to the ER for the first time in 3 years (the last time was for an asthma attack at work, they take workplace health incidents very seriously and insisted on calling an ambulance) for a broken tooth. I mentioned my allergies. The doctor could see it was a freshly broken tooth, and did give me a prescription for eight pain pills and a referral to an oral surgeon. However, he was very abrupt with me and said that if I came back in with pain of any sort they would not treat it. I didn't mention the FMS dx from years back.

Was this doctor just afraid of the DEA, or did my allergy list combined with the fact it was a toothache make him think I was a seeker? Yeah, I was seeking pain relief after the ibuprofen didn't work, but I really don't feel I was a "drug seeker" as the term is commonly used. I've never been to an ER for the pain that may be related to FMS -- the only time I've went to an ER for pain was when I sprained (and later re-sprained) an ankle and right after a car accident. The original sprain, from falling down stairs, was while I was first in college and that was when I found out I was allergic to etodolac. The resprain was five years ago. But essentially every time I've went to an ER for acute pain, I've been treated badly (in my opinion). I was never one of those patients who said 10/10, or was abusive to the nurses or doctors. What the doctor wrote, I accepted without comment and tried it to see if it worked.

If the ER docs think I'm a seeker, what is the red flag they're seeing? The FMS is hardly ever mentioned, I've usually had higher than normal for me BP when I present, and I've done my best to be cooperative with any tests, etc. Or is it just standard practice to treat patients rudely who present with pain? Maybe I've had a run of bad luck with doctors, but ... I'm wondering if it's my allergy list.

Any suggestions or red flags that show up in my history to you more experienced ER nurses?

I appreciate you listening to such a long post.

Take care,

Malanya

[CritterLover, BSN, RN]

i'm a long-term lurker, but this is my first post. i'd like to give a bit of background, and then ask a question that i hope won't be laughed at.

i'm 28 years old. i'm working in the computer industry while finishing my degree, hopefully to be a psych nurse (i couldn't handle an er after being married to a resident who was in an er rotation while waiting for an opening for ob-gyn.) at age 19, after my mother was dxed with fms, she wanted me to go to her rheumatologist to investigate the muscle pain and poor sleep i'd had for years. sure enough, with 13 of the 18 tender points, i was dxed with fms as well. (those ones at the point of the collarbone really hurt.) i was given a ton of flexeril, which just made me sleepy, and then given zanaflex, which actually worked without making me horribly drowsy. but at that time, i was also very overweight, on bcp, and also on thyroid meds. after i was single, i quit the bcp and my weight dropped off almost as if my magic (scared my pcp actually). losing the weight made a huge difference in my pain levels, as apparently i also have some disc issues and you know how weight loss helps those. anyway, have not taken any meds for fms for six years, and while i have an occasional bad spell they're not nearly as bad as they used to be.

i'm also allergic to aspirin and etodolac. (also allergic to erythromycin, clindamycin, and a now apparently withdrawn quinolone called raxar, but those are antibiotics.) having five medication allergies, apparently, is a red flag for an er. i've stopped mentioning the old fms dx because it seems like every time i do i get really bad treatment from anywhere.

my question is this. i had to go to the er for the first time in 3 years (the last time was for an asthma attack at work, they take workplace health incidents very seriously and insisted on calling an ambulance) for a broken tooth. i mentioned my allergies. the doctor could see it was a freshly broken tooth, and did give me a prescription for eight pain pills and a referral to an oral surgeon. however, he was very abrupt with me and said that if i came back in with pain of any sort they would not treat it. i didn't mention the fms dx from years back.

was this doctor just afraid of the dea, or did my allergy list combined with the fact it was a toothache make him think i was a seeker? yeah, i was seeking pain relief after the ibuprofen didn't work, but i really don't feel i was a "drug seeker" as the term is commonly used. i've never been to an er for the pain that may be related to fms -- the only time i've went to an er for pain was when i sprained (and later re-sprained) an ankle and right after a car accident. the original sprain, from falling down stairs, was while i was first in college and that was when i found out i was allergic to etodolac. the resprain was five years ago. but essentially every time i've went to an er for acute pain, i've been treated badly (in my opinion). i was never one of those patients who said 10/10, or was abusive to the nurses or doctors. what the doctor wrote, i accepted without comment and tried it to see if it worked.

if the er docs think i'm a seeker, what is the red flag they're seeing? the fms is hardly ever mentioned, i've usually had higher than normal for me bp when i present, and i've done my best to be cooperative with any tests, etc. or is it just standard practice to treat patients rudely who present with pain? maybe i've had a run of bad luck with doctors, but ... i'm wondering if it's my allergy list.

any suggestions or red flags that show up in my history to you more experienced er nurses?

i appreciate you listening to such a long post.

take care,

malanya

ers tend to get saturated with dental pain patients.

while most are happy to give an initial rx for pain meds, they can't fix the problem, and it isn't going to go away.

you need a dentist, not an er doc, right? :)

the ers where i have worked don't have that policy (only give an rx for tooth pain x1), but they have all limited the number of pain pills to 6-10.

and, to me, that isn't such a bad idea (limiting the number of rxs to one). we have such a hard time getting people to follow up. they'd rather just come back to the er, for some reason.

as for the docs attitude, some just arn't very friendly. i wouldn't read too much into it.

[caroladybelle, BSN, RN]

ers tend to get saturated with dental pain patients.

while most are happy to give an initial rx for pain meds, they can't fix the problem, and it isn't going to go away.

you need a dentist, not an er doc, right? :)

the ers where i have worked don't have that policy (only give an rx for tooth pain x1), but they have all limited the number of pain pills to 6-10.

and, to me, that isn't such a bad idea (limiting the number of rxs to one). we have such a hard time getting people to follow up. they'd rather just come back to the er, for some reason.

as for the docs attitude, some just arn't very friendly. i wouldn't read too much into it.

ditto!

the issue that you presented with is one that should be followed up with your md or dentist......not with the er.

ers are places for treating immediate problems or life threatening emergencies. many patients see them on the weekends when they cannot go elsewhere, but they are not appropriate for continuity of care.

one way to insure that people followup appropriately is to provide only enough meds to cover until they can see the correct practitioner that can provide continued care.

and as far as attitude, ers are generally very busy places, and if you can walk and talk on your own, the md is probably more worried about those cases that can't. open rudeness is an issue, a bit of of brusqueness though is understandable.

[Malanya]

ers tend to get saturated with dental pain patients.

while most are happy to give an initial rx for pain meds, they can't fix the problem, and it isn't going to go away.

you need a dentist, not an er doc, right? :)

the ers where i have worked don't have that policy (only give an rx for tooth pain x1), but they have all limited the number of pain pills to 6-10.

and, to me, that isn't such a bad idea (limiting the number of rxs to one). we have such a hard time getting people to follow up. they'd rather just come back to the er, for some reason.

as for the docs attitude, some just arn't very friendly. i wouldn't read too much into it.

i appreciate the reassurance. i was able to work with my pcp to get enough pain relief until the dental office could get me an appointment, so i was okay. too bad it took a month to get scheduled for the root canal! at least they were able to save the tooth...

mainly i was just wondering if the allergy list was what was causing it. i didn't even bother going to an er when i dislocated my kneecap last year -- well, i was able to walk on it after putting it back in place immediately after, so it didn't quite qualify as an emergency. (it was when my man saw me limping that he insisted i go to the doc -- i'd torn my mcl slightly.)

i know especially er docs have to walk a fine line between being "dr. feelgood" and treating legitimate pain. but when i've gone in to the er for acute injury, it's felt like the docs thought i was being a wimp. (my pcp actually lodged a complaint with the er after my fall down the stairs, saying that "no doctor in his right mind would give etodolac for an asthmatic patient with an allergy to aspirin" -- but that was in college in another state.)

what bothered me about the way that particular er doc handled it, though, wasn't that he said "don't come back in here for a toothache" -- he said that if i came in for any pain, he wouldn't treat it and had marked it in my chart. i felt like he saw me as a "seeker". and i couldn't for the life of me figure out why, until i started reading this board more thoroughly and saw that "long allergy list" was a sign. oh well.

i *am* grateful for the small script that got me through until i could see my pcp. and i realize that's what an er is for. i just wish he'd been a bit more ... oh, i don't know.... nice. "it's my policy not to give multiple prescriptions for toothaches because it doesn't fix the problem" would have went over better than "don't come in here again for pain, we won't treat you."

the nursing staff, i must say, was exceptional at that hospital.

take care, and again, i don't envy any of you er nurses. i would much prefer to deal with crazies than with vegetables in every orifice.

[CritterLover, BSN, RN]

mainly i was just wondering if the allergy list was what was causing it. i didn't even bother going to an er when i dislocated my kneecap last year -- well, i was able to walk on it after putting it back in place immediately after, so it didn't quite qualify as an emergency. (it was when my man saw me limping that he insisted i go to the doc -- i'd torn my mcl slightly.)

a long list of antibiotic allergies does not tend to make me think "seeker."

drug seekers tend to be allergic to non-narcotic pain medictions, and pain-medication alternatives.

i'm going to be honest, though -- i do wonder about some people that have long allergy lists, even if it doesn't incule toradol, ibuprofen, naprosyn, neurontin, elavil, flexeril, nubain and codeine.

i know it is possible to have multiple antibiotic allergies, but sometimes i wonder if all of the allergies are "real." sometimes i think the patients just have a low tolerance for the adverse effects of some antibiotics.

others seem to get some weird sort of "thrill" out of being difficult to treat. "oh, you can't give me that . or x,y,z...."kind of like patients that seem to be oddly proud that they are a "hard stick."

anyway, enough off-topic. i doubt your allergy list was the reason for the "no more pain meds" flag in your chart. more than likely, it was the dental pain. even though you had a visible sign (the chipped tooth) there are people out there that will walk around with something like that, just to get the pain meds. sometimes it is for self consumption, sometimes it is to sell. some er docs are very wary of that.