It Hurts To A Point

Common signs and symptoms of fibromyalgia. (Se...

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She sat straight up, gripping the arms of her chair as if by releasing them she might tumble forward on to the floor. “I’m tired of hurting,” were her first words to me as I entered the room. I barely recognized the person I’d seen occasionally over the last two years. She was only 32–years old but now she carried herself as if she were an octogenarian, missing only the rolling walker. “I hurt all over,” she continued. “I can’t sleep. I can barely get around at work; they even sent me home once. I’m exhausted but sleep doesn’t help. I have to do something or I could lose my job.” With that she began to cry softly, struggling to wipe away tears.

Her history came spilling out. Pain in her back, shoulders arms and upper leg muscles. Rest gave her little relief. Her sleep was fitful; if she was able to sleep more than five hours it seemed miraculous. She awoke with pain that started as she climbed out of bed and lasted all day. She tried taking Tylenol, ibuprofen, Aleve, and aspirin, first in separate small doses then in combination. All these drugs seemed to do was upset her stomach and diminish what little appetite she could muster. Consequently, she lost weight; down ten pounds since her last visit six months ago.

Her disturbed sleep pattern, accompanied by tender points of pain in different regions of the body both above and below the waist fit the diagnosis of fibromyalgia. Medicine is just now coming to terms with this disease that has become the most common cause of muscle pain in women ages 20 to 55. These patients can have numbness, tingling or burning sensations in the arms, legs or both. Not surprisingly they develop mood disorders—difficulty concentrating sometimes even frank, severe depression. Some patients with fibromyalgia also complain of chest pain or develop alternating diarrhea with constipation, what we innocently call ‘irritable‘ bowel syndrome. On close questioning she volunteered she had many of these problems.

This is one diagnosis where touch is critical—the physician’s touch. By touching over defined points of the body using enough pressure, we try to see if can elicit a pain response. On normal tissue and muscle most of us shouldn’t feel much of anything. To patients with fibromyalgia however, this pressure causes obvious pain and distress. Laboratory testing must also be done to make sure the patient doesn’t have other diseases that can mimic fibromyalgia, but usually the patient’s history reveals other reasons for their pain.

We’re not completely sure why certain patients develop this condition. There is some evidence promoting the lack of restful or stage 4 “dream” sleep as causing the pain cycle to begin. We know that exercise can help the painful muscles to relax but there’s the conundrum: if we’re too tired to exercise from lack of sleep how do we get ourselves out of this vicious cycle? This is one reason we need assurance that the patient doesn’t have a sleep disturbance, such as obstructive sleep apnea. Providing these patients with seven to eight hours of restful sleep is miraculous in breaking the grip of fibromyalgia. We sometimes use medications, such as antidepressants to help break the pain pathways in the brain and for their sleep–inducing properties. Using medications such as Tylenol or Advil can then be added to supplement and lessen the patient’s pain.

Once her examination was over she seemed to briefly relax. “The good news is you’re not crazy; your pain is real and we can get this under control,” I explained. I went on to give her the latest information about her disease and how we would approach treatment. She gave me a look that seemed to convey both skepticism but willingness to try anything to get relief and keep her job. “It takes time,” I suggested. “But we’ll get there.”

We better,” she added. “Or we’ll be out of a job.” I respect her point; serious diseases can intervene, while striving to live our lives to the fullest. Sometimes the best we can do is provide knowledge that things will get better, the tools to make it happen and the willingness to be there when it doesn’t work out the way we thought. Knowing she could lose her job if we’re not successful is real pressure and only time is on our side.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

5 Responses to “It Hurts To A Point”

  1. This is a very good article.As bad as it sounds there is still a lot more pain and symptomes to this.This describes the disease in it’s earlier stages.I started with this about twenty five years ago and it is now in the severe stage that even the prescription pain pills don’t give relief.I hope something is found soon because it runs in families. My biggest fear is for my children or grandchildren to get this.It is a horrible disease

  2. I like reading your website for the reason that you can always bring us new and cool stuff, I think that I ought to at least say a thank you for your hard work.

    – Henry

  3. This sounded just like my first visit with my rheumatologist… even the tears. Its been 4 years and lots of experimenting with the different medications. Im currently prescribed Darvocet but since it has been pulled from the market, my doctor will try me on something different at my next appointment. Im lucky enough to have a treadmill and a stationary bike to exercise with but finding the motivation is so hard! Cleaning house, caring for myself, my husband and my cats seems to take up all the energy I have. It is a difficult and lonely illness to deal with. Although the information sharing is better, there are still people (including family) that don’t believe it’s real, and think we are drug-seeking hypochondriacs.


  1. Tweets that mention It Hurts To A Point « Knowmoremed's Blog -- - October 3, 2010

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