PAIN
The literal
translation of fibromyalgia is "muscle pain". Such a simple definition for
something so sinister and so complicated. It is difficult for most
patients to convey to their friends, family and doctors what it is they are
experiencing and the impact pain is having on their quality of life. When
it comes to defining fibromyalgia pain no words seem adequate, which is common
in the description of any pain, severe or chronic. Fibromyalgia patients
describe their pain as migrating during the day from the top of their heads to
the bottom of their feet, starting in one place and moving to other body
locations throughout the day. Descriptions of shooting, stabbing, burning,
throbbing, accompany their explanations. The fact that fibromyalgia pain waxes
and wanes and moves from one place to the next is one of the most perplexing
aspects to treat in this illness. Since there are no lab tests, x-rays or
any other kind of clinical test for fibromyalgia syndrome, reports of random
chronic pain give little evidence to doctors regarding appropriate treatment. To
help give guidelines to doctors, in 1990 the American College of Rheumatology
settled on the following fibromyalgia diagnostic criteria:
-
History of
widespread pain, meaning both sides of the body above and below the waist,
which has been present longer than three months.
-
Pain in 11
of 18 tender point sites on digital palpation.
In the
introduction to "Pain and Suffering" author William K. Livingston, MD observes
that everyone knows or thinks he knows what the word "pain" means.
However, the exact definition of pain is illusive, especially in the scientific
world where precise measurement and exact amounts are required for any
believable outcome to scientific studies. The main obstacle in scientific
evaluation of pain is that it is neither objective nor a single entity.
Each pain represents a unique, subjective sensory experience that can be
described only by the conscious human being who is experiencing it.1
Even though most doctors know that pain is one of the most common reasons
patients seek medical care, education of healthcare providers in the treatment
of chronic pain has been minimal. It is often difficult and frustrating to
treat chronic pain patients, especially without tools to understand these
patients and their symptoms. Often the pain patients physical examination
may be normal or may reveal problems that do not fit traditional views of
anatomy and physiology. Laboratory tests are often normal but comorbid
conditions are common. Many times there is no one treatment of choice but a
puzzling array of therapies, each of which is beneficial for some but not all
patients. Often finding a treating physician knowledgeable about fibromyalgia
and willing to try to help alleviate some of the patients pain and other
symptoms, is one of the most difficult components to living with this chronic
illness.
1Livingston,
WK. Pain and Suffering 1998; p1.
