Joseph R. Anticaglia, MD
Medical Advisory Board
Millions heard Lady Gaga sing the national anthem at Joseph Biden, Jr’s presidential inauguration on January 20, 2021 in Washington D. C. However, how many realized she has been struggling with a disorder that has long frustrated patients and doctors?
In September, 2017 she postponed part of her “Joanne World Tour” because of chronic physical and emotional pain. She is annoyed and has been frustrated when people do not take seriously her complaints of severe pain and anxiety. Searching for years to better understand her condition, the entertainer and actress flashbacked to a sexual assault at the age of 19 and another traumatic experience when she fractured her hip in 2013.
The above episodes were clues that led to the diagnosis of fibromyalgia and post traumatic stress disorder (PTSD). She became apprehensive when fans wanted to shake her hand. She slept poorly. She had mood swings. Innocuous encounters triggered dreadful experiences. The fact that she has been overworked and not understood compounded her misery.
Fibromyalgia (FM) Invisible Pain
People with fibromyalgia suffer chronic pain throughout the body. The pain and tenderness can involve the muscles, tendons (connect muscle to bone), ligaments (connect bone to bone) and joints. The pain can be minor or severe jabbing or burning. However, most often it’s described as muscle soreness, a dull ache similar to the feeling after a long run.
The essential symptom of this disorder is widespread musculoskeletal pain on both sides of the body, above and below the waist with involvement of specific areas called tender points for three months without an explanation for the pain.
Middle-aged women comprise 75-90% of the diagnosed cases of this disease. Fibro patients are hypersensitive to pain, meaning, they experience intensified pain responses to pressure that ordinarily does not elicit pain. For example, if you exert pressure over the outside of your elbow with your thumb, if might feel uncomfortable but not painful. Not so with FM patients.
Examination
Patients with fibromyalgia often see two or three doctors before the correct diagnosis is made.. It’s more common among women 20 to 50 years of age and t’s neither an autoimmune disease nor an inflammatory disease. The laboratory tests and routine image studies are normal and physical examination is normal except for the trigger points. Therefore, some have referred to this problem as “invisible pain.”
Patients recount stories in which doctors disregard their complaints after they can’t find a “sure tell” laboratory finding. Routine X-rays are reported as normal and examination doesn’t reveal obvious findings such as swollen, tender inflamed joints. But the pain persists interfering with sleep, work, and at times, along with headaches, fatigue and mood swings.
Cause
The cause of fibromyalgia is unknown but it has been referred to as a central sensitivity syndrome. People are highly sensitive to relatively minor pain stimuli. FM can be a rare complication of hypothyroidism, rheumatoid arthritis and, in men, sleep apnea. Physical and mental traumas have been associated with FM. There has been an increase among men returning from war with PTSD and fibromyalgia.
Treatment
Patients have been comforted by doctors putting a label, a diagnosis, on their problem. A multifaceted program is most helpful for people with this disorder. Amitriptyline has shown some success although less than one half of patients demonstrated sustained relief of their symptom Exercise programs are beneficial as well as behavioral programs that include mindfulness meditation. The goal of the latter is to retrain the brain and nervous system to tone down the intensity of the pain signals.
There’s not one diagnostic test for FM. People with this disorder are sometimes called hypochondriacs and their pain is “all in the head.” Morgan Freeman, Lady Gaga and others have spoken out on behalf of fibromyalgia. As she said, “No one’s invisible pain should go unnoticed.”
Addendum
Fibromyalgia has been referred to as Fibro and FM. To make the diagnosis of fibromyalgia according to the guidelines of the American College of Rheumatology, patients must feel pain in 11 out of 18 tender points when mild pressure is applied to the areas.
Fibro has several aspects in common with Chronic Fatigue Syndrome, namely, absence of diagnostic laboratory tests absence of objective findings and an increased incidence in women 20 to 50 years of age. However, musculoskeletal pain dominates in Fibro whereas lack of energy and weariness predominates in CFS.
Reference
- National Fibromyalgia Association (NFA); Lady Gaga Shares Her Struggle with FM;
- National Fibromyalgia Association (NFA); Morgan Freeman and Fibro;
- CDC; Fibromyalgia; January 6, 2020;
- Catherine Burt Driver; William C. Shiel Jr.; Fibromyalgia; MedicineNet;
- Daniel J. Clauw, MD; Fibromyalgia, A Clinical Review; JAMA; April 16, 2014.
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.