Personalized Fibromyalgia Care
Although you have widespread achiness, your fibromyalgia symptoms consist of so much more. Wouldn’t it be nice if your doctor could personalize your treatment to address specific symptoms instead of viewing you in the same light as all people with this disease? That is the focus of a recent medical journal report written by pain management specialist Vibor Milunovic, M.D., and his colleagues in Croatia and Chicago, IL. *
Milunovic points out there is a major problem with the definition of pain as “an unpleasant sensory and emotional experience.” Adding to this vague definition that is largely useless to the practicing physician is the 1990 fibromyalgia criteria put forth by the American College of Rheumatology (ACR). It says fibromyalgia is present in a person who has tenderness in at least 11 of the 18 defined tender point areas. That definition is all about pain and says nothing about the other baffling symptoms you have such as fatigue, sleep disorder, or trouble concentrating (e.g., fibro fog).
“The new 2010 ACR criteria somewhat reduce the importance of tender points while concentrating more on other features,” says Milunovic. “The primary aspects newly introduced are fatigue, cognitive problems and waking without feeling rested. Secondary aspects include symptoms varying from irritable bowel disease to dizziness and nervousness.”
On the surface, this new criteria may seem more likely to pick up the specific types of symptoms you have besides the pain, but it falls short as well because it just generates a number ranging from 0 to 12. “This approach attempts to collapse symptoms into a globally perceived measure of dysfunction,” says Milunovic. Condensing your symptoms and their severity to just a number may be useful for following your progress in a clinical trial, but doesn’t help your doctor pinpoint specific symptoms that deserve priority treatment.
“Being able to identify key symptom clusters may reflect significant individual variability,” says Milunovic. In other words, not all fibromyalgia patients are alike, nor should they be treated that way. He goes on to suggest, “Measurement of this variability may allow for more individualized therapeutic strategies.” After all, when you go to the doctor, don’t you want to be treated for your individual complaints, rather than a number or score obtained through tender point counts or a symptom tally?
“We may be missing or mixing subpopulations of fibromyalgia patients with distinct neurobiological or behavioral characteristics,” notes Milunovic. By ignoring the subgroups of fibromyalgia patients and applying cookbook treatment guidelines by various professional pain associations, he adds that “the use of personalized medicine in research and clinical practice remains only a remote possibility.”
While most researchers in the field of fibromyalgia acknowledge many subgroups or varieties of this disease, patients with highly variable characteristics are excluded from clinical trials. So the published trials your doctor may be relying upon for treatment guidance might not apply specifically to you. Milunovic suggests various scientifically sound yet cheaper assessment tools, such as multi-probe brain electroencephalograms, be used in place of the expensive functional MRI tests to better define the various subgroups of fibromyalgia patients.
Implementing a uniform set of objective test measures to all patients and entering the findings into a massive database used by multiple countries is how Milunovic believes subgroups of fibromyalgia may be identified. He adds that the end goal is to enhance the effectiveness of treatments by enabling physicians to offer more personalized care specific to your particular set of symptoms.
* Bras M, et al. Psychiatria Danubina 23:246-250, 2001.