Jeffrey B. Loomer / M.D. Fibromyalgia and Other Chronic Painful Conditions Second Edition

The Patient's Guide and Survival Manual for Obtaining Proper and Effective
1. Auflage 2013
ISBN: 978-0-9849207-2-3
Verlag: Mystery Doc Publishing LLC
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 225 Seiten

This book was written for patients who suffer from fibromyalgia and other chronic painful conditions. I believe members of the medical community will also benefit from the book's content. As a Dartmouth Rheumatology Fellowship trained Board Certified Rheumatologist, I have been treating patients with these conditions for over 20 years. The vast majority of my private medical practice consists of patients with fibromyalgia and other chronic painful conditions. Throughout the years (through my patients) I have learned how to medically manage patients who suffer from chronic painful conditions. Even with all of the magnificent advances in medicine, people who suffer from fibromyalgia and other chronic painful conditions remain an underserved and disenfranchised component of the medical community. This should not be the case. My philosophy is that 'nobody' should have to suffer and live with chronic pain on a daily basis. This is unnecessary. There are all types of appropriate cost effective medications (generics) which are available to treat all kinds of painful conditions. The problem that patients with chronic painful conditions face is their ability to get to the right type of doctor who will not only embrace their problem, but manage their pain effectively. In my book, I systematically approach the concepts of fibromyalgia, the manifestations of this condition and other chronic painful processes, and I review available medications and their modes of actions.

Autoren/Hrsg.

Jeffrey B. Loomer, M. D.

M.D.,

Leseproben

CHAPTER ONE What Exactly Is Fibromyalgia?     This certainly appears to be a simple question, but in fact, the answer is quite complex. I often have looked at other people’s definitions of this condition. Textbooks say one thing, not much, while self-proclaimed authorities, many of them non-physicians, have written books, and of course there is the Internet, where if it is “on-line” it must be true. On occasion, while strolling through Barnes & Noble, I would thumb through the section of books on fibromyalgia, whose numbers seem to be growing annually, and I have yet to come across a book that really delves into the therapeutic management of this condition. How can one expect a nutritionist or chiropractor or psychologist (just some of those who have authored books on fibromyalgia) to be an expert on the management of fibromyalgia when they are not physicians? Most physicians do not know much about fibromyalgia, but at least they can write prescriptions for treating this condition. There may be a few patients with fibromyalgia who can derive benefit from a holistic approach towards the treatment of their condition, but they are few and far between. I am going to cut to the chase on this issue; the vast majority of people with fibromyalgia need to be on a patient-specific medication regimen to effectively control their symptoms, but I have not seen much written about the specific medication regimens that are necessary to effectively treat fibromyalgia. There may be several reasons for this. I believe that even in well-established medical communities in large urban and suburban regions, there are only at best a handful of doctors who know how to treat fibromyalgia. If we concentrate on just the physicians who treat fibromyalgia, the ones who really know what they are doing, you will begin to understand that these are unique practitioners; their patients and referring physicians are well aware of this fact. These are physicians, who for years, have been thinking and practicing medicine, in a good way, outside of the box. Before the summer of 2007, there were no FDA (Food and Drug Administration) approved medications for the management of fibromyalgia. At the time of the writing of the second edition of this book (as with the first edition), there are still only three medications that are specifically approved by the FDA for the treatment of fibromyalgia. It is important to note that these three medications have been on the market for years, but the FDA had approved them for the treatment of other conditions. I will discuss these medications and others later in the book. I have been prescribing these medications and many others for some time for the management of fibromyalgia. [Note: When a medication has an FDA approval for the treatment of a specific condition, and the physician chooses to prescribe that medication for another condition, this is known as “off-label” prescribing of the medication.] Ironically, in my opinion, there are plenty of effective medications on the market (brand names and generics) to effectively treat fibromyalgia. I have been having significant success treating my fibromyalgia patients with medications that are already on the market, some of which have been around for decades. In order to successfully treat this condition, the physician has to know what to look for and how to clinically approach the patient suspected of having fibromyalgia. Patients are frequently referred to me because of “chronic pain.” These may be individuals who for years have been dealing, most unsuccessfully, with chronic discomfort. The ways in which these patients have been managed by the referring physician varies greatly. It is amazing and sad how people can be managed ineffectively for years. I always wonder one of two things: why these physicians did not refer these patients out sooner; or why these patients did not, on their own, seek out more effective management? In reality, the answer to this question is rather complex, and in most cases, no one is to blame. It can be quite frustrating for the general physician to manage patients with chronic painful conditions; many are uncomfortable treating these patients. If a doctor is to be effective, in managing patients with chronic painful conditions, they have to be comfortable, particularly in the prescribing of narcotics. There are plenty of patients who are, in fact, appropriate candidates for the prescribing of narcotics. In my opinion, if a physician, for whatever reason, refuses to incorporate the judicious use of narcotics in their practice, they will be ineffective in managing chronic pain in a fair number of patients who fall into this category. How does a physician begin to develop a productive working relationship with the patient with chronic pain? It does not take long during the initial visit with a new doctor to get a sense where this new relationship is going. The attitude of both parties (physician and patient) is extremely important during the first visit encounter. A doctor, who is comfortable treating patients with chronic painful conditions, will not feel intimidated when a new patient comes to their office complaining of chronic discomfort with years of prescribed narcotic usage. Sometimes a patient on a complex pain management regimen actually will discharge their primary care physician, and seek help from a different primary care physician. The problem, in this situation, is the new primary care physician may be uncomfortable with prescribing opioids (narcotics), and the patient is right back where they started. Often, doctor offices have signs posted in the waiting room stating they do not prescribe narcotics. They tell the patients that they will manage all of their other conditions and write prescriptions for their other non-pain management medications. The only good thing for the patient in this situation is that these doctors tell their patients up-front they do not manage chronic pain, and they usually have a pain specialist to whom they will refer them. My approach, to the patient who comes to my office complaining of chronic pain, is quite simple. I need to spend at least 50 minutes with a new patient. I want to review the records the patient has brought with them. Patients will sometimes get upset if their records were not sent to my office ahead of time. Patients usually know what tests were done and their results. I am often quite effective with making a diagnosis on the basis of taking a good history from the patient followed by a careful physical examination. Personally, I feel it is important for the doctor to obtain the history from the patient, and it goes without saying that the doctor should perform the physical examination. In order to effectively manage the patient, with a chronic painful condition, the clinician has to determine the etiology (cause and origin) of the pain. Not all painful conditions are fibromyalgia, but patients with chronic painful conditions often have fibromyalgia. To determine if someone has fibromyalgia, the physician has to have a good understanding of what to look for. So, here is the million dollar question (which due to inflation, a struggling economy, and after taxes is really worth about half a million dollars). What is fibromyalgia? The answer is rather straight-forward. Fibromyalgia is a syndrome. What is a syndrome? A syndrome is a collection of clinical features which as a whole defines a medical condition. Now that you know the definition of a syndrome you can begin to understand, and possibly identify, this condition in yourself; however, do not take it upon yourself to start diagnosing your family and friends. It is alright for a patient to have an understanding of a condition before going to a doctor. Just remember, you will not be an instant expert, and keep in mind a competent physician, during the course of an initial evaluation, will be considering other diagnoses too. I often have patients who either are referred to me, by their primary care provider or come on their own, telling me they think they have fibromyalgia, and they are usually right! The most common scenario, regarding the fibromyalgia patient, is they are referred to me with the presumption of another diagnosis, such as, rheumatoid arthritis or lupus; the patient will say to me their blood work showed one of these two conditions, and I was going to treat it. This is a perfect example of a referring physician innocently missing the boat. An abnormal blood test certainly does not make a diagnosis. A positive rheumatoid factor (one of the blood tests used to diagnose rheumatoid arthritis) does not necessarily mean a patient has rheumatoid arthritis. A positive ANA (antinuclear antibody), a test used to diagnose lupus and other connective tissue diseases, does not mean a patient has lupus. The results of these tests can certainly mislead the practitioner who ordered them, not to mention scaring the patient. It may take several months for a new patient to get an appointment to see a rheumatologist, and during that time they are worrying about a condition they really do not have. To make things worse, for the last several weeks, they also may have been on the Internet learning all about “their new condition” including both accurate and inaccurate information. Now, my job has the added complexity of deprogramming these patients and explaining to them what they really have. My favorite situation is when the primary care physician tells their patient they have a connective tissue disorder (such as, rheumatoid arthritis, lupus, or another diagnosis that falls under my field of expertise), and the patient chooses to embrace an inaccurate diagnosis by their primary care physician after I have told them they do not have that condition! Now, they think that I do...