Fibromyalgia

sbic56, BSN, RN · Mar 25, 2004

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.

nursedaisy · Mar 25, 2004

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.

teeituptom, BSN, RN · Mar 25, 2004

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

teeituptom, BSN, RN · Mar 25, 2004

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

nicki2 · Mar 27, 2004

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.

Editorial Team / Admin · Mar 27, 2004

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

veetach · Mar 28, 2004

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.

RNin92 · Mar 28, 2004

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.

RNin92 · Mar 28, 2004

Sorry...didn't mean to rant.

I'll climb down from the soap box now.

Nightcrawler, BSN, RN · Mar 28, 2004

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

SunnyKC · Mar 28, 2004

While I do believe that fibro is a real disease...from all the reading I have done on it...it does tend to be misdiagnosed A LOT...more than other CP problems.

The biggest problem in diagnosing it is that there is no one clear test to prove it. Some of it is trial and error (ruling out other things) but from what I understand its the trigger points that most docs go off of.

There is a pretty active fibro board on the forum I am normally at. Lots of good info there. Again from my reading, most of those with the disease do NOT take narcs. There are a few that do..but most find narcs dont help much with the pain they have. Knowing that most fibro patients dont want narcs...does that make it easier to accept as a real disease?

I can certainly understand your FF's coming in and spouting out that they have fibro and only MS04 or whatever their doc is. I would think that would make it pretty obvious they are seekers.

I strongly believe ALL people in pain should have pain relief. But I also believe there are conditions out there that narcs dont help enough to warrent taking them all the time. And I believe Fibro is one of those. There is a whole range of meds and treatments that help with fibro. I believe just recently there was a new med put on the market that treats fibro among other things.

The people that have their pain, and other symptoms under control...utilize any number of things to reduce the pain. Some go to PT and get relief..others go see a chiro or massage. Most take one anti-depressant and usually a NSAID also.

Sorry I didnt mean to write a book. I just felt I had some good info to add..to hopefully educate someone that wasnt aware of this info.

It isnt likely at all that a true patient that has fibro will walk into the ER demanding narcs. So I think it would be pretty obvious who is seeking and who is for real. But I have never worked in the ER so I cant say that for sure.

My hat is off to you all that work in the ED every single day. You are much more disciplined that I could ever be.

RNCENCCRNNREMTP · Mar 28, 2004

I love these "fashionable" diagnoses

Fibromyalgia

Chronic fatigue (Epstein Roseanne barr)

Hypoglycemia (not diabetes)

Mitral valve prolapse

I knew I was in trouble in the ER when a young woman came in and listed ALL of these as her past history.

Aaaaaaarrrrrrrrrrrrrrgggggggggggggghhhhhhhhhhhhh!