Medical Specialists for Fibromyalgia
As you approach the management of your fibromyalgia, it is important to assemble a versatile and well-rounded team of medical specialists to assist you with your care plan. In order to build the most effective team, it will be important for you to screen and “interview” potential members to ensure that they have not only the right skills to contribute to your team, but the right attitude and understanding about fibromyalgia. When you meet with a medical specialist, be sure to ask for any examples they may have of treating former patients with fibromyalgia. In addition, ask them to discuss different treatment options they have used in the past and what the outcomes of those treatments were, along with any additional observations they made along the way (side effects, tolerability, patient feedback, etc.). Also be sure to ask what they think of the various alternative therapies that have been researched in relation to fibromyalgia, such as chiropractic and massage therapy. Above all, it is vitally important to recognize that while these medical specialists will be the experts on your team, youare the team captain and should serve as the means by which they communicate with one another. Once your team is assembled, be sure to keep each specialist apprised of what the other is doing or has done with regard to your fibromyalgia management; this is where tracking and medical record management (as described in Chapter 6 of our eBook) will be of great use to you.
The following is a non-exhaustive list of medical specialists who you may wish to include on your team, along with a description of what they treat and various aspects of fibromyalgia they may be helpful in managing.
Primary Care Physician
A primary care physician should be key to your team. When choosing a primary care physician, it is important that you find someone who is willing to listen to your concerns, ideas and opinions, who will take your input seriously and who accepts that you are the leader of your fibromyalgia management team. Be sure to choose a primary care physician who has experience with fibromyalgia patients, and who is knowledgeable of strategies to manage breakthrough pain.
Primary care physicians are usually internal medicine doctors (also known as internists) or general practitioners (also known as family medicine doctors). They are typically a patient’s main physician and source of healthcare. They perform annual physical examinations and are trained to treat a number of general and systemic conditions. When you begin to develop symptoms of an illness or disease, you typically consult your primary care physician first. While your primary care physician can establish a diagnosis of fibromyalgia, they may also refer you to appropriate specialists in order to rule out (or co-diagnose) other conditions, such as rheumatoid arthritis or chronic fatigue syndrome. A primary care physician can also help you assemble a multidisciplinary team of specialists to treat your fibromyalgia once a diagnosis is achieved.
Rheumatologists are internal medicine physicians who have received additional training in the diagnosis and treatment of arthritis and other diseases of the muscles, joints, and bones. Rheumatologists commonly treat arthritis, autoimmune diseases, pain disorders, and osteoporosis. Many individuals with fibromyalgia may see a rheumatologist early in the course of their diagnosis in order to rule out arthritis and other musculoskeletal pain disorders. Since rheumatologists are specially trained to treat patients who have chronic pain conditions, they are often an integral part of a fibromyalgia patient’s treatment team.
Orthopedists are medical doctors who specialize in diseases and injuries of the musculoskeletal system, which includes muscles, bones, tendons, and ligaments. While the prevailing understanding of fibromyalgia is that it results from the body’s inability to properly process pain signals, rather than actual bone or joint disease, an orthopedist can be a useful specialist to help diagnose fibromyalgia. Much like a rheumatologist, orthopedists can help to rule out other diseases that have similar symptoms, such as osteoarthritis and rheumatoid arthritis. For example, an individual who’s fibromyalgia manifests itself mainly as persistent pain in their knees, hips, and neck may at first need to visit an orthopedist to rule out a diagnosis of osteoarthritis.
Neurologists are medical doctors who specialize in the diagnosis and treatment of diseases that affect the nervous system. Like rheumatologists, neurologists are often one of the first specialists seen by fibromyalgia patients on their quest for a diagnosis, as certain neurologic diseases must be excluded. In addition, the current understanding of fibromyalgia among many experts is that it results from the body’s inability to process painful stimuli correctly. Since nerves are the means by which the body transmits and processes pain, neurologists are often integral members of a fibromyalgia patient’s team.
Psychiatrists are medical doctors who specialize in the prevention, diagnosis, and treatment of mental illness. They also monitor the effects of mental illness on other physical conditions, including heart disease and high blood pressure. Psychiatrists are well-trained to help patients who are suffering from depression and anxiety, both of which are extremely common among fibromyalgia patients. As medical doctors, psychiatrists can write prescriptions for medications that may be useful to fibromyalgia patients in managing their depressive symptoms.
Psychologists are specialists who have received extensive post-graduate education in the assessment, diagnosis, treatment, and prevention of mental disorders. While generally not permitted to prescribe medication, psychologists treat patients through other means, including talk therapy, cognitive behavioral therapy (a type of talk therapy that helps patients understand how their thoughts and feelings affect their behavior), and behavior modification techniques. Psychologists can be instrumental in the care regimen of patients who are suffering from depression and anxiety, by helping them recognize events that trigger or worsen their depression, and identifying ways to cope with symptoms. Like psychiatrists, psychologists can be a vitally important part of a fibromyalgia patient’s care team.
Chiropractors are specially trained practitioners who focus on treating disorders of the musculoskeletal and nervous systems, in an effort to modify the effects that these disorders have on an individual’s overall health and wellbeing. Chiropractors are not medical doctors, however they must complete four years of post-graduate training in a chiropractic college and pass both national and state licensing exams. Chiropractic care is commonly used to treat back and neck pain, joint pain, and headaches. Although research surrounding the usefulness of chiropractic care as a treatment for fibromyalgia symptoms is conflicting, some patients do find that chiropractic care improves their symptoms.
Massage therapists are specially trained practitioners who use therapeutic touch and pressure applied to muscles in order to relieve pain, rehabilitate injuries, reduce stress, provide relaxation, and relieve anxiety and depression. For fibromyalgia patients, massage therapy may be useful to help reduce pain and promote relaxation in an effort to improve depression and anxiety.
Occupational therapists are specially trained, licensed healthcare providers who assist individuals who are experiencing difficulty with activities of daily living. They receive detailed training related to the physical and psychological difficulties associated with illness and the effects that these have on people’s ability to perform everyday activities. Occupational therapists modify an individual’s environment to fit their changing needs. This can obviously be beneficial to fibromyalgia patients, who are frequently forced to change the way in which they live as a result of the persistent pain they endure. Occupational therapists can help fibromyalgia patients modify their homes to better accommodate the physical limitations they face, which can result in improved symptom control.
Registered dieticians are healthcare professionals who apply principles of food and nutrition to health and human functioning. They hold nutrition-related degrees that include studies in biochemistry, human anatomy, and physiology. They are also required to completed dietetic internships of at least 900 hours. In addition, dietitians are required to pass national board exams. Dietitians can be useful to fibromyalgia patients who suffer from many common co-existing symptoms and diseases, such as irritable bowel syndrome, obesity, and interstitial cystitis.
Physical therapists are licensed healthcare professionals who are trained in the diagnosis and treatment of movement disorders. They work with patients to improve the body’s functioning by restoring mobility, reducing pain, and preventing disability. Since fibromyalgia patients frequently suffer from decreased mobility as a result of their chronic widespread pain and stiffness, a physical therapist can be helpful in teaching patients how to overcome physical challenges they face.
Naturopathic doctors focus on the holistic and proactive prevention of disease, as well as comprehensive diagnosis and treatment. Naturopathic physicians (N.D.) attend four years of post-graduate naturopathic medical school, during which they are educated in all of the basic sciences as medical doctors (M.D.); however, their studies also include education related to holistic and nontoxic therapeutic approaches, with an emphasis on disease prevention and the optimization of wellness. They are also required to complete four years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, psychology and counseling, and must also pass professional board exams. Naturopathic doctors may be useful members of a fibromyalgia patient’s treatment team in order to provide many complementary and alternative therapies that have may be of benefit, including acupuncture, aromatherapy, and so forth.
Holistic Medicine Practitioner
Holistic medicine focuses on addressing care of the whole person – body, mind and spirit. It integrates both conventional and alternative therapies in an effort to foster optimal health and wellbeing, and prevent disease. Holistic medicine practitioners are useful to fibromyalgia patients because they focus on patient care in terms of the unique needs of the patient, rather than through a one-size-fits-all approach. The practitioner-patient relationship is viewed as a partnership that encourages patient input and needs. This individualized, highly-attentive relationship can be of great benefit to fibromyalgia patients, as the disease itself is highly unique on the individual-level and required a patient-directed approach to treatment.
Finally, it is important to recognize that your team of specialists will likely not remain static throughout the course of your treatment and ongoing management efforts. As you try out and evaluate different therapies, some of these specialists may come and go from your roster, depending on which therapies are most beneficial to you. The faces on your team will be as ever-changing as your fibromyalgia.