Fibromyalgia is a common disorder involving chronic muscle pain (either a deep ache or a burning sensation) and fatigue. Its cause is unknown, and there is no cure. The syndrome has been recognized since the late 1800s, when it was called fibrositis, said Dr. Daniel Hamaty, who is partially retired from his Charlotte rheumatology practice.
In 1990, the name fibromyalgia was endorsed by the American College of Rheumatology. Estimates are that 3 million to 5 million Americans have the syndrome. It is the second most common disorder seen by rheumatologists, next to rheumatoid arthritis. Women are 10 times more likely to have it than men.
Still, like Cooke, many fibromyalgia patients complain it takes years to get a diagnosis. This is because no evidence appears on X-rays or in laboratory tests. People with fibromyalgia often look healthy. Some doctors may conclude patients have psychological problems.
"I was appalled that most physicians generally tended to regard the patients as psychosomatic," said Dr. Glenn McCain, a Charlotte rheumatologist, about his experiences in medical training. "My interest in fibromyalgia developed as my rebellion against this view, 20 years ago, that these patients weren't really deserving of treatment."
Research has led more doctors to accept fibromyalgia, McCain said.
One of the most important findings was all fibromyalgia patients register pain at predictable "tender points" when doctors apply pressure with a finger. There are 18 such points for doctors to test, spots where healthy people wouldn't feel pain if touched.
Skeptics suggest many people feel tenderness on those spots and its measurement is subjective, but McCain said a doctor can determine tenderness with the same reliability as blood pressure if the exam is done properly. Many researchers believe fibromyalgia is an abnormality in the way the body handles pain.
"When pain stops, that's not a passive event," McCain said. "The body turns off the pain."
In fibromyalgia patients, pain stimuli come in normally, but the brain doesn't turn off the pain with its usual effectiveness. Some researchers believe that injury, physical or emotional trauma or even an infection, such as a flu virus, may trigger fibromyalgia. Some believe it is related to a lack of growth hormone, produced at night by the pituitary gland and used to repair muscles. Without such repair, muscles are sore, the theory goes. Treatment for fibromyalgia involves symptom relief.
"Medicine is much more than finding a cure," McCain said. "Most patients you can help by simply being understanding, practicing your craft and providing care."
Patients with the same levels of pain cope with it differently. Some get by with anti-inflammatory drugs and low-dose antidepressants to relieve pain, promote sleep and reduce depression. Others may not be able to work, become depressed, have difficulty in relationships and turn to narcotics for pain relief because milder drugs don't work.
Those patients need a pain management program, said McCain, who refers patients to the Presbyterian-Orthopedic Center for Pain Medicine. There, in addition to getting pain medicines, patients work on exercise programs and learn how to live with the pain better.