1) Medical marijuana is vastly preferable to Lyrica, Cymbalta, and Savella — the three drugs approved by the Food and Drug Administration for the treatment of fibromyalgia.
2) Many patients diagnosed with fibromyalgia have become dissatisfied with their medical advisors.
How did this unusual state of affairs come to pass?
It seems to me that we are witnessing the end of an era in medical history that commenced in the mid-1980s when North American rheumatologists began to apply their clinical acumen to shed new light on a mystery that had defied the best efforts of their forebears to solve it.
I am referring to the condition they named Fibromyalgia Syndrome (FMS), which had over many years been variously known as Fibrositis, Soft-tissue Rheumatism, Muscular Rheumatism, and Neurasthenia.
Their initial interest was sparked by an observation that many patients with hitherto undiagnosable widespread pain were more “tender” than expected in regions of their body that did not necessarily bear any relation to where they reported feeling pain. By a strange process of logic, it was argued that this finding showed that they were not imagining their condition or faking it.
In 1990 the American College of Rheumatology (ACR) announced new classification criteria for FMS that hinged upon the presence of both widespread pain and tenderness at 11 or more “tender points” arbitrarily chosen in 18 regions of the body. Although these criteria were meant to facilitate research, they were soon being used for clinical diagnosis.
Along with these criteria were a number of allegedly “typical” symptoms, including fatigue, sleep disturbance, cognitive deficits, bowel and bladder dysfunction, and mood changes. When the tender point count was less than 11, the presence of these symptoms allowed a diagnosis of FM to be made. However, most rheumatologists failed to appreciate that these features are similar to those of stress/sickness responses observed in animals.
Armed with an official rheumatological diagnosis, FMS spread around the globe and North American sufferers banded together to form support groups that successfully lobbied the U.S. Congress for research funding.
Thousands of research papers provided an avalanche of data, but unfortunately a credible hypothesis did not emerge nor was a causative agent or mechanism identified. Little wonder then that the prescribed medical treatment for fibromyalgia proved to be so ineffective.
Some 20 years after the publication of the classification criteria, the ACR decided to remove the tender point count as a criterion for diagnosis and replaced it with a series of questionnaires well designed to measure the extent of “polysymptomatic distress” experienced by sufferers. It appeared that many rheumatologists had been so sure of their ability to make the diagnosis that they did not bother to perform a tender point count.
Gradually a realization of their relative therapeutic impotence dawned upon rheumatologists, many of whom removed themselves from an unsatisfactory situation that was of their own making.
The responsibility for management of patients with FM was passed back to primary health care practitioners, who were equally baffled by the complexity and intractability of this condition.
A large number of sufferers, together with their many support groups, have been left high and dry by those academic researchers who initially enlisted their lobbying support to secure research funding.
This leaves us with a number of questions to answer. Did rheumatologists ignore the important clues that suggested a plausible biological explanation for FMS?
Were they looking in the wrong place for answers? Will FMS now disappear from the lexicon of medicine, as did the previous labels? What will replace it? Will another medical speciality express interest in the condition?
And will medical marijuana become the drug of choice in the pharmacological management of people with widespread pain?
Some blasts from the past about marijuana:
Cannabis is an anti-spasmodic, anaesthetic, narcotic, and a powerful aphrodisiac. In large doses it produces mental exaltation, intoxication, and a sensation of double-consciousness. It is a valuable hypnotic in delirium tremens, and useful for painful affections of the bladder and for functional impotence. It is also used for nervous headaches. From: George M Gould and Walter Pyle. A Cyclopedia of Practical Medicine and Surgery. Philadelphia: P Blakinson’s son and Company, 1900.
It has been estimated that that it is habitually used for its intoxicating effects by from two to three hundred millions of the human race, and there is evidence to show that, when indulged in for a length of time, it produces loss of appetite and strength, and considerable mental weakness. From: The Family Physician. London: Cassell & Company, Limited, 1884: 813.
John Quintner, MD, is a rheumatologist and pain medicine specialist in Australia who recently retired from clinical practice.
He has published numerous articles on chronic pain in Pain Medicine, Clinical Journal of Pain, The Lancet and other medical journals.
The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.