New York, New York—Better understanding of the brain chemistry anomalies in fibromyalgia have established fibromyalgia as a legitimate medical condition and paved the way toward more effective treatments, experts tell Musculoskeletal Report.

“Physicians have doubted the existence of fibromyalgia and we are showing that ‘you are wrong, this exists and we have concrete evidence,’” says Nathan Wei, MD, a clinical director of the Arthritis and Osteoporosis Center of Maryland in Frederick, Maryland. “Fibromyalgia is a real condition due to a problem of chemistry in the brain.” Dr. Wei and others are calling attention to this pain disorder because September is National Pain Month.

fMRI now primary diagnostic test in fibromyalgia

So what has fueled the growing acceptance? “I think it’s a combination of increased public awareness, increased physician awareness as well as the production through research of medications designed to change brain chemistry,” Dr. Wei says.

The past few years have also heralded advances in diagnosis of fibromyalgia. “The primary diagnostic test that has helped us in terms of determining that this is truly a disease is functional magnetic resonance imaging (MRI),” he says.

Fibromyalgia treatment: CBT, exercise, meds

Dr. Wei likens treating fibromyalgia to a 3-legged stool. Cognitive behavioral therapy can help with short- term memory and other cognitive issues, non-impact exercises such as swimming and stationary bike riding can help the body release its endorphins, and medications targeting serotonin, dopamine, norepinephrine and gabapentin can correct brain chemistry abnormalities,” he says.

“More than just shoving pills, fibromyalgia treatment involves this 3-legged stool and it takes a lot of hard work for patients, families and physicians,” he says.

There is no one-size-fits-all approach to the treatment of fibromyalgia, and there are obstacles along the way.

“We try to select a medication that best deals with the particular symptom complex,” he says. Treatment also involves breaking down some barriers to regular exercise. “Many people with fibromyalgia don’t want to exercise, but it is such an important part of whole treatment program,” he says. “You don't have to run a marathon, try walking for a minute or two a day and gradually increase this.”

While there have been some tremendous advances in recent years, there is more work to be done, Dr. Wei says.

Fibromyalgia neuro pathways still need mapping

“As we begin to understand the complexities of neurotransmitters in the brain, we will target fibromyalgia therapies better,” he says. “We know that the common pathways are covered, but there are probably 10 to 15 other pathways that we are not targeting or not aware of yet, and as our ability to do that improves, we will treat fibromyalgia much more effectively,” he predicts.

Mildred Farmer, MD, internist and geriatrician at Meridien Research in St. Petersburg, Florida, thinks that fibromyalgia’s day has arrived—finally.

“There is going to be increasing acceptance now that we have tools to impact quality of life among fibromyalgia patients and better general understanding of the pathophysiology,” Dr. Farmer says. Still, roadblocks exist. “Every physician needs a personal level of confidence when it comes to diagnosing a clinical syndrome in the absence of a blood test,” she says.

Dr. Farmer says that fibromyalgia has been a stepchild diagnosis, but “in patients with somatic complaints and diffuse body aches and pain, the tender point assessment is a very easy and fairly accurate diagnostic evaluation in the absence of other significant diagnoses.”

In these instances, “give fibromyalgia a chance,” Dr. Farmer urges.