Dr. David Clark, DC -Functional Neurologist- Dallas, TX confesses he was wrong about Fibromyalgia.
I need to make a confession to you if you’re suffering with fibromyalgia:
What I thought I knew about fibromyalgia was wrong.
This comes out of a little journey I’ve been on the last few years of taking everything I thought I knew about Fibromyalgia and challenging it....
...thinking, “What does new science have to say about this? Is the science telling me something that can change what I think about Fibromyalgia?”
Look, All doctors can get into a rut where they think they’ve got it “figured out.” With some patients, you get really good results and you start thinking, “Well, this is all I need to know.”
And that’s a very dangerous way to be, because it makes you a lazy doctor---and with fibromyalgia, I got lazy.
A few years ago, I told people that, “Fibromyalgia isn’t really “real.” I mean it’s real that you hurt, but that diagnosis doesn’t really mean anything.”
And to be fair, I was partially right.
The diagnosis of fibromyalgia using the criteria established in 1990 doesn’t mean very much,. Here’s why: the key thing about the criteria that was developed in 1990 was the patient had to have 11 of 18 tender points. Well, new research in the last 2 years discovered that doctors who were diagnosing women with fibromyalgia over the last 20 years weren’t even using those criteria correctly.
Most of the time, doctors weren’t even physically touching the patient. They were not checking those tender points, so the diagnosis was a joke.
That’s where I was coming from.
However, I wasn’t really offering much of a solution either, and I was thinking that the diagnosis doesn’t mean anything; but it does.
There are two kinds of fibromyalgia diagnosis.
- What I call the “legitimate diagnosis” of fibromyalgia.
- The “garbage can diagnosis” of fibromyalgia – also called the “B.S. diagnosis” of fibromyalgia.
So what do I mean?
Well, the legitimate diagnosis of fibromyalgia is difficult to make (until now, see below), because there is no gold standard test. It’s not like you go to the doctor and they run a test and say, “You’ve got cancer.” There is no test to run to tell you you’ve got fibromyalgia, all they know is about your symptoms; and here’s what the current research tells us.
To have fibromyalgia, you’ve got to have these three things.
- Widespread pain
- Sleep problems.
What kind of pain?
The pain doesn’t have to be just in those old 1990 tender points, the pain can be anywhere, but the pain does need to be widespread, not “focal”– meaning not just in your shoulder, or just in your lower back.
What does “fatigue” mean?
Well, you’ve got to feel tired. You’ve got to have a problem with low energy. You’ve got to have either: – feeling like you could sleep...or you just feel weak in your mucles... you don't have the strength to contract your muscles.
What kind of sleep problems?
As for “sleep problems”, you’ve got to have the problem of staying asleep... or going to sleep....or your sleep is not restful or restorative.
Those 3 things together are necessary for the legitimate diagnosis of fibromyalgia.
Now notice, by the way, I did NOT say you had to have depression, anxiety, or physical/sexual trauma in your past...I didn’t say any of that.
What’s the “garbage can” diagnosis?
The garbage can diagnosis of Fibromyalgia occurs when you go to your doctor (and he/she means well) with a chronic pain, and after a while they say:
“Mrs. Smith, I don’t know why you hurt...Maybe you’ve got fibromyalgia.”
That’s a B.S. diagnosis...because there probably IS a reason why you hurt. You don’t necessarily have fibromyalgia.
But, if you’ve got some pain that starts in your shoulder for example and then --- because you don’t get good treatment or don't receive a correct diagnosis---that pain spreads over your body...You may end up with legitimate fibromyalgia.
When you suffer pain and inflammation, those two will disturb how you think. They will make you feel like you are fatigued, and they can disturb your sleep.
I was wrong with what I thought I knew about Fibromyalgia. I didn’t understand that whole history lesson about the fact that doctors weren’t even using those tender point criteria, but were diagnosing and medicating anyway.
That was mind-blowing....
Now, it’s so bad that doctors are diagnosing fibromyalgia with only a questionnaire!!
If you answer “yes” to 2 out of 6 questions the doctor says “You’ve got fibromyalgia. Let’s get you a prescription for Lyrica,.”
Why do doctors now use a simple questionnaire to diagnose a complex condition like Fibromyalgia?
The idea was that it was taking too long to get these 1990 tender points examined. Because he takes insurance, the doctor only has ten minutes to get you in and out.
So, 20 years later traditional medicine is trying to find a way to diagnose people in ten minutes because the doctor only has ten minutes to see an insurance patient visit...And he needs a reason to get you started on a medication.
Rarely, are you going to go to a medical doctor’s office where the doctor is not going to feel a pressure to give you something. That’s why you came, right?
So the doctor needs a medical justification for why they’re giving you the medication. Justification? Diagnosis: Fibromyalgia.
That’s the B.S. garbage can diagnosis.
I encourage you to find someone that understands that there’s a legitimate diagnosis, and a legitimate way to go about reducing, if not eliminating, all those symptoms.
But--Fair Warning--- Fibromyalgia is complex, so the doctor you see needs to be a detective and needs to understand these critical areas:
- The immune system
- Nitric oxide
- Brain function
- Infections -- parasties, viruses, bacterial, Lyme
That's just for starters.
The most important thing your doctor needs to understand is that it means something specific to have fibromyalgia. It's not all in your head. It should not be a garbage can.
Your doctor needs to understand the difference between the legitimate diagnosis and the garbage can diagnosis.
I sure didn't understand the difference, at least not until I chose to admit that what I thought I knew about Fibromyalgia was wrong.
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© 2012 David Clark. All Rights Reserved.
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Dr. David Clark, DC
Functional Neurologist (FACFN)
Diplomate College of Clinical Nutrition
Board Certified Chiropractic Neurologist
Vestibular Rehab Specialist (ACNB)