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Doctor's Diagnosis: Fibromyalgia


I have always found that one of the most difficult undertakings in all of medicine is to look a patient in the eye and say, “I don’t know.” After years of training, the last thing in the world you want to do is explain to a sick patient that you simply do not have the answers to many of the questions that are so important to them.
Patients usually assume that once they are given a diagnosis their doctor has a full understanding of their disease.

Unfortunately, a patient given the diagnosis of fibromyalgia may hear their physician say “I don’t know” quite often because. The simple truth is that there are many essential but unanswered questions concerning fibromyalgia.

Typically, patients with fibromyalgia complain of chronic incapacitating muscle pain. Additionally, these muscle pains often are associated with multiple other problems, such as easy fatigability, difficulty with sleep, joint pain and depression, all of which make simply getting through the day extremely challenging.

Fibromyalgia is a “clinical diagnosis.” This means there are no lab tests or imaging studies, such as X-rays or CT scans, that are useful for diagnosis or guiding treatment.

The diagnosis is based on the patient’s description of symptoms. Additionally, fibromyalgia patients often have 9 pairs of “tender points” in very characteristic areas such as the back of the skull and outside part of the elbow. When the examiner presses on these areas, most people experience a simple pressure sensation. Fibromyalgia patients, on the other hand, frequently experience intense pain.

The cause of fibromyalgia is poorly understood but may involve some abnormality in the way the nervous system processes pain sensations.

Even though much is not known about this disease, much can be done to help these patients. Medications such as Lyrica have been approved for fibromyalgia. Other medications can help with the pain, depression and sleep disturbances. Psychological counseling and support groups can help, along with exercise, physical therapy, massage and tai chi are essential in keeping patients active.
Complementary therapies such as message and tai chi help many patients.

Most important of all may be accepting the challenge of having both the doctor and patient get past the disappointment of dealing with a disease of which so much is not known and working together using the wealth of information that is available.

Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at


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