I do believe there are patients who have widespread musculoskeletal pain attributed to a syndrome we call fibromyalgia. However, I do not believe rheumatologists should be the “main caregivers for these patients,” as Pisetsky and others have suggested. We simply treat these patients by default. The main reason for my stance is the lack of any creditable evidence supporting fibromyalgia as a rheumatologic condition other than the existence of chronic pain. Although rheumatic diseases are often associated with chronic pain, the converse is not necessarily true. With the burgeoning entrepreneurial specialty masquerading as “pain management,” my opinion is that these patients would be best served by those who claim to be pain specialists—if only we could get them to put their needles down long enough to actually treat the pain and the patient.
Dr Pisetsky states FMS is not a rheumatic disease and therefore not under the realm of what a rheumatologist should be treating. I actually do not disagree. I agree that a rheumatologist is the specialist to be seen to get a FMS diagnosis, but I doubt they are great in the treatment department. The first one I saw, because I presented symptoms of lupus or RA, told me I had ‘hypermobility syndrome with chronic soft tissue pain’ and that was that. The second one I went to said I had FMS but that I was too young for any medications and that was that. Thanks. So very helpful. While the syndrome shares some symptoms with diseases these specialists do treat I find they flounder with FMS, reluctant to treat pain as pain and wishy-washy about what to do. Which leaves the FMS patient pretty much in limbo. There general doctor will often not be able to fill the gap, they may try a few things, but pain management is beyond them. It is the reason I have never had any effective treatment of this syndrome and it has kinda fallen to the side in the face of chronic migraines. I think a pain management clinic is the way to go, pretty much the only way to go. So the dude is right if I had FMS and I was his patient I would totally ditch him.
On the other hand, the reply to this article suggests otherwise:
Who else can manage fibromyalgia better than a dedicated and caring rheumatologist? We are the best diagnosticians, bar none. We are better at using drugs than anybody else, even with our hands tied behind our backs. Managing a fibromyalgia patient is like having one’s hands tied behind one’s back. Furthermore, drugs don’t work very well in these patients, and just telling a patient that they must exercise also does not work. As I write this, I realize that in some respects managing a fibromyalgia patient now is somewhat akin to what is was like managing a rheumatoid 35 years ago when I started practice. Maybe that is why I am not resentful in having to take care of these patients.
It has occurred to me that if I were not able to use opioids in the management of fibromyalgia, then I, too, would lose interest in taking care of these patients. Opioids are to fibromyalgia what corticosteroids are to rheumatoid arthritis. We try to avoid them if possible, but when they are necessary—which is often—we should employ them. Maybe, just maybe, Dr Luetkemeyer refuses to give these patients opioids for whatever reason. If that is the case, I could understand his frustration and his decision not to treat these patients. — Dr Murray Sokoloff
Now that doc sounds like he would go the course with his patients, FMS or otherwise. I want him at my back any day. He suggests some may not want to treat FMS because it is difficult to treat, and I think that is the very reason… so the recipe to follow and no sure results. He points out that RA back in the day had no easy treatments either. So all specialists are not born equal it seems. Pity in small areas we simply cannot pick and choose.