Highlights from PAINWeek 2013

This class was taught by Gary W. Jay, MD, FAAPM, a pain medicine and management consultant from Raleigh-Durham, North Carolina.

Dr. Jay began the class stating, diagnosis of fibromyalgia is not one of exclusion but based on clinical characteristics, the primary hallmark of which is chronic, widespread pain of 3 months or more in duration.

Dr. Jay made sure to emphasize several times that people with fibromyalgia must be treated within a medical model. He provided "students" with the new 2010 American College of Rheumatology (ACR) diagnostic criteria for Fibro stating the new ACR diagnostic criteria requires three conditions be met:

1) a widespread pain index (WPI) ≥7 and symptom severity (SS) scale score ≥5 or WPI 3 to 6 and SS scale score ≥9;

2) symptoms have been present at a similar level for at least 3 months; and

3) the patient doe not have a disorder that would otherwise explain the pain.

Note: I was just a wee bit disappointed that as a patient, I knew something doctors didn't know. The Fibro Diva Report discussed the new 2010 ACR diagnostic criteria for FM this past summer.

Dr. Jay informed attendees that, the pain of FM can wax and wane, and, intensity may vary, as may physical location of pain.

He listed the usual symptoms of Fibromyalgia: fatigue and sleep disorder, tenderness, stiffness, mood disturbances, cognitive difficulties, and admitted that FM can be the cause of multiple areas of functional impairment.

Dr. Jay emphasized that physicians and other healthcare providers realize that people with Fibromyalgia often have difficulty climbing stairs, walking two blocks, and with activities of daily living.

In addressing the issue of disability and Fibro, Dr. Jay stated . . .

Fibromyalgia has a negative effect on careers, mental health, and personal relationships, with increased work absences, decreased productivity, and higher direct/indirect medical and other costs.

Dr. Jay informed the Master Class students that, Fibromyalgia is currently a clinical entity within the spectrum of central sensitivity syndromes, which includes chronic fatigue syndrome, irritable bowel syndrome, temporomandibular disorder, restless leg syndrome and periodic limb movements in sleep, idiopathic low back pain, multiple chemical hypersensitivity, headache (tension-type, migraine, mixed), interstitial cystitis, chronic pelvic pain and endometriosis, and myofascial pain syndrome.

Dr. Jay concluded the workshop with a mention about treatment that I found particularly interesting. Dr. Jay said . . .

"Fibromyalgia is more difficult to treat because people with FM commonly have significant hypersensitivity to the prescribed medications.

FDA-approved agents to treat fibromyalgia are pregabalin, a gabapentinoid, and two serotonin–norepinephrine reuptake inhibitors, duloxetine and milnacipran. These drugs should be started low and slowly titrated [increased] in patients."