Redefining a disease

Peter Ste-Marie (left) with Dr. Mary-Ann Fitzcharles discussing a fibromylagia case in the MUHC Rheumatology Clinic at the Montreal General Hospital.

Diane Brodeur was diagnosed with fibromyalgia four years ago, although she believes that she has been suffering from the disease for much longer. This dynamic sexagenarian from the Montreal region experiences joint, tendon and muscle pain, along with insomnia on a daily basis. Upon diagnosis, she decided to take control of her disease.

“When my doctor diagnosed me with fibromyalgia, I didn’t really know what it was. I thought it was something that affected people suffering from depression,” says Brodeur. “I said to myself, ‘My God, will I have to live with this pain for the next 30 years of my life?’”

Like Brodeur, over one million Canadians suffer from fibromyalgia—a syndrome that remains a mystery to many, but which is progressively being unravelled by the scientific community. Fibromyalgia occurs most commonly in middle-aged women, but can also affect men, children and the elderly.  Some people can experience mild and troublesome pain, whereas others may have more severe symptoms that impact normal daily activities.  Typically, pain is present for everyone, including aching muscle stiffness and sometimes a burning sensation. Most sufferers also experience fatigue, sleep disturbance and mood disorder. These symptoms may be dealt with for years without being diagnosed or receiving treatment recommendations. 

Clinician researchers at the McGill University Health Centre (MUHC), in collaboration with their colleagues across Canada, have developed new national guidelines to help family doctors diagnose and treat fibromyalgia over the long term. These researchers also conducted a clinical review of fibromyalgia that was recently published in the Canadian Medical Association Journal (CMAJ), based on the 2012 Canadian fibromyalgia guidelines.

“For the first time, we have developed guidelines that cover the diagnosis, treatment and follow-up of fibromyalgia,” says Dr. Mary-Ann Fitzcharles, an MUHC researcher and rheumatologist, who adds that the medical community has needed an update since 2006. “There is currently no known cure for fibromyalgia, but these guidelines offer a new concept of patient tailored treatment, which includes both non-pharmacologic and pharmacologic
strategies.” According to the authors of these guidelines, fibromyalgia is now considered a valid condition. This illness is a true multi-symptom disease that can affect patients and their families.

Fibromyalgia was traditionally diagnosed by rheumatologists, but because of the sheer number of people with this condition, it is now recommended that diagnosis and care be centered in the primary care setting, with only a select minority of patients requiring specialist consultation. First-line doctors are therefore in the best position to manage patients, as recommended in the 2012 Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome.

“The common perception is that 90 per cent of patients with fibromyalgia are women, but we are starting to question this data,” explains Peter Ste-Marie, a research assistant and coordinator who works with Dr. Fitzcharles. “Men probably get this condition in a higher proportion than is reported, but for reasons unknown, the current data does not reflect this hypothesis.”

The authors strongly recommend the importance of non-drug therapies that require active patient participation such as exercise, relaxation techniques, and cognitive behavioural therapy. There is no magic medication, but drug choices should be tailored to patients’ individual needs and carefully monitored. The main treatment goal is to improve quality of life by easing the most problematic symptoms, with pain being the most common and most troublesome.

Antidepressants have been traditionally used to treat fibromyalgia as they are recognized to have pain modulatory effects, but for Brodeur, their use is often limited by side effects. “I had too many unpleasant side effects, such as nausea and insomnia,” she says. Indeed Brodeur stopped taking the antidepressants prescribed by her doctor to control her fibromyalgia. “I also changed my diet and now eat more fruit, vegetables, lean meat and less processed foods. And I go to an aquafit class because it’s easier for me to move in water,” she says with a smile. “I still have a long way to go, but I’m determined to manage this illness as naturally as possible.”

The researchers encourage the healthcare community to recognize fibromyalgia as early as possible in order to limit unnecessary and anxiety-provoking investigations and instead focus on health. Brodeur has already volunteered and was accepted for a clinical research study on fibromyalgia.

Please visit the following website to access the new Canadian Fibromyalgia Guidelines: http://www.canadianpainsociety.ca