Friday, 13 January 2012


Do you know what Rheumatology is? It’s pronounced room-a-tol-oh-jee. I used to think it was the study of claustrophobia... you know, people who can’t get enough ‘room’. But no – rheumatology is the study of the rheumatic diseases.

“Isn’t rheumatics how air brakes work?” you ask.

No, Grasshopper. THAT is pneumatics. Rheumatic diseases refer to arthritis and rheumatism.

“Oh great!” you sigh. “How many ‘rheums’ does this bozo have?”

It’s simple, my young Padawan. Arthritis refers to pain in joints; and rheumatism is pain in muscles and other soft tissues like tendons.  Anyway... it turns out that Rheumatologists (that’s just rheumatology misspelled) and Neurologists (nerve doctors) are slugging it out over who gets to treat fibro... and neither group wants it.  The Rheumatologists point out that, though fibromyalgia USED to be considered a form of muscular rheumatism, recent research now indicates that it is, in fact, a disease of the brain and nerves. On the other hand, Neurologists point out that it was rheumatologists who first came up with this wacky condition in the first place. “So you take it. No, you take it. No, you take it. No you take it.” And so on.

Meanwhile, anaesthesiologists who run pain clinics point out that most fibro patients have pain just about everywhere... “So where the HECK do I put the fricken needle?”

And veterinarians... well, they haven’t weighed in on the issue yet.

But now there’s great news for all these specialists! Now, NONE of them have to see you.


Because new, IMPROVED diagnostic criteria have just been published that do away with the classic tender point examination, which has been the mainstay of diagnosis since 1990. Now, instead of any doctor taking the time to actually examine you, all that’s needed is a questionnaire that asks you if you hurt and then asks you where.

It’s even fun. The questionnaire gives you 19 different choices where you might hurt... your left upper leg, your right upper leg, your left lower leg, your right lower leg... and so on. And once you’ve finished you move on to rate the severity of your fatigue, waking unrefreshed and cognitive problems. Then, finally you’re asked if you have headaches, lower belly pain or cramps, or depression. It’s kind of like ordering at a Chinese restaurant. “I’ll take numbers 5, 8, 14 and 17, some won ton soup, and, oh, those cute little almond cookies.”

Once you’ve ordered, you then get to find out if you have fibro or not, by adding this to that and this to that and multiplying everything by your old Aunt Edna’s bra size and Voila! You get a score that either says ‘Yes, you have fibro” or “No, you have rabies.”

It’s so simple. You can be diagnosed in the waiting room, just by filling out the questionnaire yourself, BEFORE the doctor sees you. And if your hands are so bad you can’t hold onto a pen... no worries! You usually have to wait so long anyway, by the time you’re seen you can probably form life-time friendships with other people waiting, or trace each other's geneology back 17 generations to find out that you're distantly related... and then maybe they’ll fill the questionnaire out for you. And all without the doctor ever touching you.

What’s next - an even newer version for on-line use?  Hey, they could make that one even simpler... just one question:  “Do you feel like shit?”

 “Congratulations! You have fibro!”

And now you don’t even have to go into the doctor’s office to fill out the questionnaire in the waiting room.


But I hate these new criteria, and here’s why...

First, if all you need is a questionnaire, specialists will no longer have to see you. And if specialists no longer have to see you, they will MISS other problems that often co-exist with fibromyalgia. Just where oh where on that questionnaire do you indicate that your fricken nose has fallen off? The fact is that people with fibromyalgia are at increased risk of having a host of other rheumatic conditions, like osteoarthritis, rheumatoid arthritis and lupus. And if you don’t have those things, you might have treatable localized conditions like shoulder or hip bursitis or carpal tunnel syndrome or tendonitis of the heel that could be fixed with a simple shoe insert. But if no one examines you, NO ONE WILL KNOW.

And second... who’ll believe you? If you have trouble making your family doctor believe you NOW, even after a specialist has confirmed that you have fibro, how will it be for you if you go in saying you diagnosed yourself on an on-line shopping channel, or while cruising porn sites?

Now, to be fair, many Rheumatologists are still happy to see you, though I've seen more and more start saying No; and a small percentage of Neurologists, who generally call themselves functional Neurologists, see fibro patients too. And the new questionnaire was supposedly created only for research purposes; mind you, the same can be said of the old criteria, and they became the gold standard for diagnosis. And the new questionnaire is not INTENDED for self-administration, though I'm sure it's only a matter of time before it is.

But I'm still concerned. WHAT the heck was WRONG with the old criteria anyway? And how do these criteria improve anything? My fear is that many specialists will see these new criteria, that require no physical examination to confirm fibro, as another reason they don't need to see you; and more doctors in general will see them as yet another reason to justify calling fibro a non-physical disease, despite a mountain of evidence now proving otherwise.

And whatever criteria you use, THAT'S pronounced STU-PID!!!

Kevin White, MD, PhD

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