Fibromyalgia

Malanya · Feb 8, 2008

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.

i truly wish that for the mycin family it was just the standard "stomach issues" that apparently a lot of people have with erythromycin -- it's hives, and it really limits what a doctor can do. he's never even tried a z-pack with me getting hives from two different mycins. my mom can have a bad respiratory infection and take six pills and be done with it -- and i really envy her that.

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."
i just don't get how that would give someone a thrill. do they like having black and blue arms or something? oh well, crazy is crazy... and the first thing i learned in ab psych is not to try to understand crazy, just to deal with it without becoming crazy yourself.
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.
anyone who walks around with a cracked tooth is a much more pain-tolerant soul than i am, i guess, unless the nerve is already dead or something. everyone told me that a root canal was a painful procedure -- bs! once he had me numbed up, all i noticed was pressure, and you never saw a happier soul than i was after that dental appointment. he gave me a script for vicoprofen for "after pain" that i gave back to him when they put the permanent crown on it. i knew it'd been hurting some before it finally broke (then it was exquisite), but i didn't realize just how bad it was really hurting until they root-canaled it and i woke up after the numb wore off, pain free. (feel free to pass on my story to anyone you know who has a dental phobia -- i wanted to kiss that dentist, and i'm happily attached!)

I love my cat! · Feb 8, 2008

I have edited to withhold my personal opinion

Why? I think a difference in opinion makes a good discussion!

I love my cat! · Feb 12, 2008

interesting about the allergies. allergies, specifically multiple chemical sensitivities (mcs) is common is people with fibromyalgia.

i suffer from a lot of allergies. environmental, food, medications, animals, etc.

when i have gone into the md/er and they ask for my allergies, i tell them. if i am met with eye-rolling, heavy sighs and sarcastic, "anything else?", i then take out the paperwork from all of my allergy tests and present them. they can see for themselves, the results from the 4 days of skin testing and blood work. they can read the allergists notes on my reactions to medications. they can see the skin-prrick reactions and the ige levels in my blood work.

boy, do their attitudes change fast!!!!!

all i can say is thank goodness there are allergy tests! i can only imagine the judgmental attitudes towards a person suffering from fibromyalgia pain and allergies and not having anything on paper to "prove" that their allergies are legitimate. so, not only are they making up their pain, but now they are making up their allergies and their reactions?

to add. i feel dental pain is severely undermedicated. i had a temp inlay placed over my back tooth. as i was leaving the office, i could feel the pain and my mouth was still numb! they told me to take ibuprofen. i told them that i would need something stronger because if the pain is this bad now, it will only get worse. i know my body. nope. take ibuprofen. well, about 12 hours later, i was in excruciating pain. the side of my face felt as though it was going to explode. i called the after hours number and got through to the dentist and explained my situation. she called in 20 vicodin. that saved my life. had she not called in the medication, i would have gone to the er.

when the permanent inlay was ready (about 3 days later) i went back. when they were removing the temp inlay, they could see that a flap of skin/gum had been folded over and pinched with the temp inlay.....hence the excruciating pain.

i told them so, but apparently at this office, pain isn't what the patient says it is.

they left the room and i saw my chart open on the table, so i looked at it. the secretary had written in big, red letters patient seeking vicodin. i was so angered by this and i mentioned it, too. i told them that am not a drug seeker, but a patient seeking pain relief and if i was a drug seeker, would i really be spending $1000 on dental work for 20 lousy vicodin? please, give me a break.

i never went back to that dentist again.

CathyRN06 · Mar 19, 2011

Teeituptom-- Please let your supervisors and coworkers know how you feel and request that you not be assigned patients with an FM diagnosis. It is truly unfortunate that a definative diagnostic test has not yet been developed or discovered for FM. However, in the meantime, please keep in mind that FM is truly a medical diagnosis and if you can't provide objective care to FM sufferers you need to be responsible enough to let your fellow staff members know. You are a great example of why people who have FM "time" their visits to make sure that either certain people are or aren't working when they come in seeking help. I also believe that the diagnosis of FM is overused. I'm not a doctor. If I have a patient with that diagnosis it is not within my scope to re-diagnose. One of the things I have observed, however is that once someone is diagnosed with FM a lot of health care providers tend to turn a deaf ear to any future complaints of pain, discomfort, etc. Recently while working on an orthopedic surgery unit I took care of a patient in her early 40's with an FM diagnosis. Because of her diagnosis all of her providers disregarded her increasing complaints of hip pain--until she could barely walk she had severe degenerative arthritis and had to have a hip replacement! Did her FM symptoms resolve? Absolutely not-- but the hip pain and decreased hip mobility did. On a personal note, I have a very good friend and coworker for more than 15 years who was dx'd with FM approximately 6 years ago. She was eventually labeled as a "frequent flyer" by the medical profession whom she was trying to gain help from. She finally found a neurologist (you got it, she doc shopped until she found someone who would listen to her and provided her with the respect she is entitled to as a human being and as a patient) who did additional work up for her. Her experience have been a total nightmare and I truly wish that she would put them in a book. Depressed, absolutely! In part caused by a feeling of helplessness and the condemnation she received by less than objective medical "professionals". Fibromyalgia is still one of her two primary diagnosis... the other is multiple sclerosis. This wonderful kind hearted woman / nurse / mother / former ballerina has multiple sclerosis. Because there are still so many health care people out there who "turn off" their objectivity when someone with FM diagnosis or FM symptoms comes along, no one bothered to listen to her symptoms of MS. My friend had several productive years that she could have spent enjoying life had someone listened to her. Instead, she spent those years and a lot of time and money trying to obtain medical help for her symptoms and getting the door slammed in her face over and over again because she knew that something was wrong with her and no one would believe. As nurses, we have a professional responsibility our patients. If we are unable to give those patients the care they need, if we are unable to support a diagnosis (you might not be able to prove it... but can you disprove it????) that a doctor has made, then we probably shouldn't be nurses. At the very least, we shouldn't be accepting the responsibility for care for patients who have a diagnosis that we are unwilling to provide proper care for. So, do your patients a favor, either educate yourself, trust and believe in what your patients are telling you (while using some good nursing judgement of course!) or remove yourself from caring from patients whom you are providing a disservice and possibly even harming by your care.

I sit here in tears as I read this. I was an ER nurse with CEN, TNCC, PALS, ACLS and at one time considered being a flight nurse. Five years ago within a month I was flat on my back.

I may have met some here with the attitudes I recognise. It pains me that my own medical/nursing colleagues has to ask me, "What did you do with all your money," "Come one now, you just wanted a few days off, didn't you?"

A year later I was in an assisted living facility. I still fight for healthcare - and no, I don't take narcotics but sometimes the pain is so bad that I cry at night.

I'm ashamed to be part of this establishment who points fingers and doubts.

allstudentnurses, ASN, RN · Mar 19, 2011

I personally make an effort not to care if the diagnosis is valid or not, if someone comes in and says they are having pain, no matter where it is, I do everything within my nursing power to resolve the situation. I try really hard to leave the determination of valid or invalid diagnosis / drug seeker or not a drug seeker up to the physician. There have been times where the patient was an obvious drug seeker and so I told the physician that I felt they were seeking, but that's usually only in obvious cases.

But...

We, as humans, still know very little about the human body (especially the brain) and for some to say fibromyalgia is a crap diagnosis boggles my mind. How can you give a definitive opinion about something when you don't fully understand what you're giving an opinion about?

It would be different if "you thought" you fully understood something and gave an opinion on something based on what you "thought" to be factual, but everyone knows we don't understand the human brain and it's a great mystery at this point in humanity, I think it's very presumptuous to say Fibromyalgia is a crap diagnosis, how do you really know? Especially since the brain is where all pain in interpreted and relayed.

I hope I haven't offended anyone with this post, but I felt the need to say it.

izeofblu1973 · Mar 21, 2011

I am just curious to see if the nay sayers of FM also agree that PMS and migraines are also fake? They cannot be proven and are based on the sufferer's account for a diagnosis.

usalsfyre · Mar 22, 2011

The typical FM patient ED sees:

Has an Axis II disorder

Has allergies to all non-narcotic and many low-level narcotic pain management options

Has multiple narcotic prescriptions from multiple physicians

Often has a heavy duty anxiolytic prescription to go along with the narcotics

Regularly has medication that is "stolen" or "lost".

Usually complains of horribly non-specific pain, usually ranking "11 or 12" out of 10.

Has enough radiation exposure from multiple non-diagnostic imaging studies for the above non-specific complaints to glow in the dark.

Threatens at least once a visit to report the staff for "not taking them seriously" this time.

Has at least 20 visits in a 12 month period to the ED (and often has 20+ at multiple EDs).

Has never sought out a pain management specialist.

So it's a little hard not to get jaded by this complaint. I don't doubt there are some real FM suffers out there. However, 90% of patients make the the other 10% look bad. I actually wish I could not automatically think "bull feces" when I hear FM in a patient's history. But I've seen the patient above too many times.

NorthBay · Mar 22, 2011

^ Exactly. The "fibromyalgia" patients that I see in my ER tend to be our completely drug-addicted, often homeless, frequent fliers who happen to show up when it rains outside and claim they "lost" the oxy prescription for 60 pills that we gave them two weeks ago (but they did fill it, according to the records). They are the ones who used to have "chronic back pain" and "a pinched nerve". They happen to be allergic to Vicodin, Percocet, Morphine, Toradol... but not Dilaudid or Demerol. They don't have a PCP (so how did this "fibro" get diagnosed?) and no doctor, including the one who supposedly diagnosed them with fibro, will refer them to a pain specialist. As a matter of fact, they have NO desire to work with a pain specialist ("just give me Dilaudid/Demerol and I'll be good to go").

When you have patients like that time after time, it's hard to not raise an eyebrow at someone who comes to the ER with a chief complaint of fibro flair up. Do I believe it really exists? Sure. Absolutely. Do I think people who actually suffer from fibromyalgia come to the ER weekly demanding the most extreme narcotics on the face of the earth? Nope. Not for a moment. And that, my friends, is why fibro has a bad name in the ER circuit.

On a side note, I did have a patient last week who had fibro in her history (though she wasn't there for a fibro-related-complaint). Did she want narcs? Nope. She controlled it with anti-inflamatories, light exercise, plenty of rest, eating healthy, and the occasional muscle relaxant. This thread encouraged me to sit down and talk with her about her fibro. I'm 100% certain she actually had true fibromyalgia.

**canoehead, BSN, RN** · Mar 24, 2011

The criteria for fibromyalgia are totally subjective, so it's a good bandwagon for drug seekers to get on. When I see someone diagnosed with fibro and they are obviously in pain, not in the drugseeker category I feel like their doc has let them down. Fibro is a set of symptoms, a syndrome, with no known cause or cure. It's a very much abused diagnosis. Just putting that label on an honest patient can make them marginalized as far as attentive care.

If I had it, and I had to go to the ER, I would not mention it as a diagnosis. I might say chronic muscle pain, with no known cause yet, but not the F word.

Munch · Apr 3, 2011

Fibromyalgia is a condition where some people believe it is real and some people don't. My apologies that I haven't read through all the posts before so if this has been said before...sorry. But for a condition that isn't real, why in the world did the FDA approve three medications to treat it? Lyrica(the gold standard for fibro and it seems to work really well), Savella(a SNRI) and Cymbalta(Also a SNRI). I am a 28 year old nurse diagnosed with fibromyalgia or "fibromyalgia" as some say and I still go to work every day thanks to Lyrica. Fibro is usually diagnosed after an emotional or physical trauma(for me it was a bad car accident on Christmas eve, someone hit me head on). Not only do I get muscle pain, I also get muscle spasms, stiffness, IBS, tension headaches and nerve pain. I don't suffer from depression, but some patients do(Like some said wouldn't you be depressed if you had all these symptoms and people telling you, that you are crazy to boot)? To say that Fibro isn't real is insulting. It's still a condition that is a mystery. Luckily my amazing PCP ran every test in the book to make sure it wasn't something else(like Lupis, RA or Lyme disease that have similar symptoms) sent me to a pain management doctor that not only believes in it, but specializes in it(how can you specialize in something that isn't real)? The first meeting with my pain management doctor, all he did was tap a spot on my elbow and I nearly jumped off the table. Lyrica really is the medication that gave me my life back as well as celebrex, and zanaflex. If I have a flare up my doctor prescribes me vicodin just to get me through, but that doesn't happen often. Heating pads, acupuncture, a gluten free diet, frequent massages and exercise help a lot too. A lot of non-medicinal ways really do help with the symptoms. Fibro is real and believe me I have had my share of doctors(even doctors I work with) tell me it's all in my head. It doesn't really matter to me anymore, think what you want to think, before I got treated I was rolled up on a ball on my couch unable to move, I had to take a leave from work, it was just terrible. Many books are written on the subject, maybe the non-believers should pick one up and read about it. Oh and if I have to go to the ER(I had a car accident recently, and I had a kidney infection a year ago), I go to the hospital where my PMD works(he's an anesthesiologist there) and he comes down and takes care of me no questions asked. It makes me so angry that a lot of people ruin it for the patients who REALLY suffer from it.

steelydanfan · Apr 7, 2011

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.

If I had a pt. come to the ER with complaints of fibromyalgic pain I would be sorely tempted to explain to them what an ER is FOR!

steelydanfan · Apr 7, 2011

I see it too, and sadly enough I think it is becoming a diagnosis that will qualify people for SS disability. This is a scary thought. 20 years ago we called it "aches and pains" and got up and went to work anyway. Times are a'changin......

Hey, when leg twitches are now diagnosed as "restless leg syndrome",and drugs are advertised all over TV for it, anything goes! Let's ALL go on disability and stay stoned!

Really, I'm just getting cynical and disgusted by bigpharma and the people who are so willing to "be sick" instead of dealing with life and its handouts in a productive, positive way. Sorry, this just hit a nerve.