FWD:Fibromyalgia is tough to pin down, tough treat

Fibromyalgia is tough to pin down, tough treat


The diagnosis
The American College of Rheumatology has established criteria for diagnosis of fibromyalgia as widespread pain lasting more than three months and tender points on both the right and left side of the body in 11 of 18 standard sites.
One in five adult Americans reported they suffered from chronic pain – pain lasting for several months or longer – according to a 2005 survey by Stanford University Medical Center, ABC News and USA Today. According to a 2003 study in The Journal of the American Medical Association, pain costs American workers more than $61 billion a year in lost productive time.
According to a July 2007 study by the American Pain Society, about 4 percent of patients who use opioids under medical supervision become addicted.

Chronic pain survey
Chronic pain is defined as pain that continues a month or more beyond the usual recovery period for an injury or illness or that continues for months or years because of a chronic condition. The most common sources of chronic pain are lower-back problems, arthritis, cancer, repetitive stress injuries, shingles, headaches and fibromyalgia. Sometimes there is no apparent cause.
The Voices of Chronic Pain survey found that as a result of pain, more than three-quarters of patients feel depressed, 70 percent said they have trouble concentrating, and more than half said their pain put a strain on relationships with family and friends.
The survey also found that more than three-quarters of patients are looking for new treatment options. Only 14 percent said they were satisfied with their current medications, and less than half felt they were getting enough information on the best ways to manage chronic pain.
Previous: Five patients died on his watch

By Elizabeth Simpson
The Virginian-Pilot
February 1, 2009
Sue Maxwell describes her pain as feeling like someone is slowly bending her bones.

For Lois Reid, it's more of a generalized ache that brings a fatigue that robs her of focus during the day and sleep at night.

Maxwell and Reid have fibromyalgia, a disorder that causes chronic and sometimes debilitating pain.

Both are former patients of Dr. Stephen Plotnick, a Virginia Beach physician who last week gave up his medical license for at least two years and promised never to treat chronic pain patients again.

Plotnick's agreement with the Virginia Board of Medicine followed board allegations that he failed to properly prescribe and monitor powerful pain drugs. Five patients died and others were permanently injured under his care, according to board records. Most of them had been diagnosed with fibromyalgia.

Plotnick specialized in aggressive treatment of the condition, and his case shows the high stakes for doctors and patients in managing chronic pain.

For local fibromyalgia patients like Maxwell and Reid, the case highlights the difficulty they have getting relief. More than 20 years after the American Medical Association recognized the disorder, many doctors are still skeptical of patients' claims of pain or are not confident about how to treat it.

Most doctors agree that the best treatments for fibromyalgia, which affects 10 million Americans, are antidepressants, physical therapy, certain types of exercise, and fairly new medications developed for the condition - Lyrica and Cymbalta. Most people find relief from those approaches.

For a minority of patients, however, those measures might not work.

Some of them find relief through narcotics - which doctors refer to as opioids - such as methadone, OxyContin and morphine.

Many doctors, though, are reluctant to prescribe narcotics for a variety of reasons: concern that patients will abuse the painkillers or become addicted; the potential for death or disabling side effects; and the scrutiny of medical boards and of the Drug Enforcement Administration, which tracks prescriptions for narcotics.

After Plotnick's license was first suspended in August, his patients scrambled to find doctors to prescribe the same drugs so they wouldn't get sick from suddenly stopping the medicine and so their pain would not return.

Patients expressed worry in online chat groups, at a local support group and during interviews that they wouldn't find the kind of outspoken support Plotnick provided for those with fibromyalgia or other chronic pain disorders.

"There are thousands of people in this area suffering severely with chronic pain and who have no quality of life because doctors are afraid to prescribe narcotics," said Judy McClary, a fibromyalgia patient and a consultant for others with the condition. She has taken narcotics for years.

"I know we need guidelines and checks and balances, but we need a balance," said McClary, who often referred people to Plotnick. "People can't be afraid if their doctor has a stroke or accident, there's no one else to give them medication."


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http://hamptonroads.com/2009/01/fibromyalgia-tough-pin-down-tough-treat