Letter to Doctors Who Don’t Believe in Fibromyalgia

Doctor I have fibromyalgia !! And today I come to your consultation because I need your help .

When I come with you I hope to find empathy and knowledge , but also humility and scientific curiosity in the face of what you do not know.

Fibromyalgia Epidemiology

It’s true. The fibromyalgia is a little common disease. According to the study you review, you will find that it affects 1 to 6 per 100 people (Worldwide prevalence of 0.2 to 6.6%).

That means if you saw 20 patients a day, Monday through Friday. Between 4 to 24 patients with this disease would pass through your consultation.

But if you do not know about this disease , you will neither suspect it nor treat it adequately.

Fibromyalgia medical ignorance

And this is what happens in many cases.

Doctors who know the fibromyalgia hide their academic and scientific ignorance, in phrases how are you:

“I do not believe in fibromyalgia – That is in the mind – It is something imaginary – That is a disease of concerned and controlling people – When we doctors do not know that a patient has a patient we say that he has fibromyalgia.

The fibromyalgia is the disease of hypochondriacs You’ve tried a priest to make you a healing? That I know about the spirit – She is crazy, everything is in her head – At least you don’t have cancer – She is grateful that it is not lupus.

What they invent for a disability – It is impossible that all that hurts at the same time – and what do you want me to do? the miracles to Lourdes – When you come to my office without being able to walk, I believe you not before.

When you have many symptoms it is because you have nothing – Accept that you are already a certain age – Your mind somatizes everything – You have the fashionable disease of women – Could it be that you are looking to attract attention? ” 

** These are all real phrases, revealed by patients who have been a victim of them.

I don’t know if you think the same as me, but it’s sad …

The lack doctor hurts, it hurts, dilates the time of diagnosis and therefore the start of treatment, thus affecting the quality of life of who suffers from fibromyalgia .

Join to Living with fibromyalgia group

Do you believe or not believe in fibromyalgia?

Many doctors claim they don’t believe in fibromyalgia .

But, Fibromyalgia Doctor, it’s not about whether or not you believe in it, it’s about keeping your medical knowledge up to date .

Did you know that the World Health Organization (WHO) already considers it a disease ?

Yes, and it’s not something that came out in the last medicine journal last night. Since 1992, the WHO has included fibromyalgia within ICD 10 (International Classification of Diseases).

And no, it is not within the category of somatoform diseases (invented by the patient’s mind), it is within the category of musculoskeletal diseases .

If you don’t believe me, check it out.

The ICD-10 code for fibromyalgia is M79.7

No longer diagnosed by sore spots

But even before the WHO included it in the international classification of diseases, as early as 1990 the American College of Rheumatology (ACR) had proposed the term fibromyalgia and issued the first diagnostic criteria for this disease.

1. Generalized pain in combination with
2. Tenderness in 11 or more of the 18 specific pain points or trigger points

Which were reevaluated by the same academic institution several years ago (2010).

How to make the diagnosis of fibromyalgia?

In 2010, the ACR proposed the current version of the diagnostic criteria , using two scales:

1. Generalized pain index ( WPI )
2. Symptom severity scale ( SS )

Achieving a sensitivity of 96.6% and a specificity of 91.8% .

So as you can see, the diagnosis is highly reliable , based on these criteria .

And yet today some doctors still make the diagnosis with trigger points .

But, it’s not just about the American College of Rheumatology.

Let me share with you the guides from many other academic institutions that support the existence of fibromyalgia .

• Recommendations for the management of fibromyalgia (2017)  EULAR (European Alliance of Rheumatology Associations)
• Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome (2012)
• Fibromyalgia diagnostic criteria (2019) AAPT (alliance between FDA and the American pain society)
• Israel Rheumatology Association : Guidelines for the Diagnosis and Treatment of Fibromyalgia Syndrome (2013)
• SER (Spanish Society of Rheumatology) Recommendations on the management of patients with fibromyalgia (2021)
• Fibromyalgia Syndrome: General Principles and Coordination of Clinical Management and Patient Education (2012) – AWMF (Association of German Scientific Medical Societies)
• New guidelines for the diagnosis of fibromyalgia (2017) Brazilian Society of Rheumatology
• Guidelines for the successful management of fibromyalgia patients (2014) Indian Association of Rheumatology

Sources:

Marques, AP, Santo, ADSDE, Berssaneti, AA, Matsutani, LA, & Yuan, SLK (2017). Prevalence of fibromyalgia: literature review update. Brazilian Journal of Rheumatology ,  57 (4), 356-363.

World Health Organization. International Classification of Diseases Tenth Revision (ICD-10) Volume 2. 2003 Edition.
Available: http://ais.paho.org/classifications/Chapters/pdf/Volume2.pdf

Wolfe F.,  et al. The American College of Rheumatology 1990 Criteria for the classification of fibromyalgia. Arthritis Rheum. 1990;33:160–172.  Disponible: https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780330203

Wolfe F., et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62:600–610. Disponible: https://onlinelibrary.wiley.com/doi/pdf/10.1002/acr.20140

Galvez-Sánchez, C, et al. Diagnostic criteria for fibromyalgia: Critical review and future perspectives. Journal of clinical medicine, 2020, vol. 9, no 4, p. 1219. Disponible: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230253/

Diagnostic and management guides

Macfarlane, G, et al. EULAR recommendations for management of fibromyalgia. Annals of the rheumatic diseases, 2017. Disponible: https://ard.bmj.com/content/76/12/e54

Fitzcharles M.A., et al. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: Executive summary. Pain Res. Manag. 2013;18:119–126. Disponible:https://downloads.hindawi.com/journals/prm/2013/918216.pdf

Arnold, L, et al. AAPT diagnostic criteria for fibromyalgia. The Journal of Pain, 2019, vol. 20, no 6, p. 611-628. Disponible:https://www.jpain.org/article/S1526-5900(18)30832-0/fulltext

Ablin JN, et al, Israeli Rheumatology Association: Guidelines for the diagnosis and treatment of the fibromyalgia syndrome. Harefuah, 2013, vol. 152, no 12, p. 742-7, 751, 750.

REDONDO, J, et al. SER recommendations on the management of patients with fibromyalgia. Part I: diagnosis and treatment. Rheumatology Clinic , 2021.Available: https: //www.ser.es/wp-content/uploads/2020/11/Recomendaciones_SER_FM_DEF.pdf

PETZKE, F., et al. General treatment principles, coordination of care and patient education in fibromyalgia syndrome: Updated guidelines 2017 and overview of systematic review articles. Schmerz (Berlin, Germany), 2017, vol. 31, no 3, p. 246-254.

HEYMANN, R., et al. New guidelines for the diagnosis of fibromyalgia. Brazilian Journal of Rheumatology , 2017, vol. 57, p. s467-s476.

BENNETT, R. Guidelines for the successful management of fibromyalgia patients. indian journal of rheumatology, 2014, vol. 9, p. S13-S21.

Fibromyalgia Doctors