The following is based on an interview with Dr. Garret Rock of Fibromyalgia Centers of America-Colorado performed in July, 2008.
Treating fibromyalgia is very marketable for clinics. This is due to the number of people in the U.S. with fibromyalgia, and their desperate need for help. Sadly however, many clinics and practitioners are exploiting this need and attempting to treat a condition they know little about.
In this interview, Dr. Garret Rock, the lead case manager at Fibromyalgia Centers of America-Colorado shares information every fibromyalgia sufferer should know before choosing which care is best. Dr. Rock shares what treatments are proven effective, and which may lead to disappointing results.
Q. What are the signs and symptoms of fibromyalgia?
Dr. Rock: The three primary symptoms of fibromyalgia are widespread pain, fatigue, and sleep disturbances. Rarely do sufferers only experience these three symptoms. Most often they have associated conditions and symptoms. Some of the more common are irritable bowel syndrome, brain fog, depression, numbness and tingling, chemical sensitivities, muscle cramps, anxiety, and restless leg syndrome.
Q. Why is fibromyalgia being marketed by so many practitioners?
Dr. Rock: First off, many health care disciplines have shown some degree of success in treating fibromyalgia. It is a complex condition, with many systems of the body being affected, and therefore people are likely to experience some results with nearly any type of treatment. So you get different disciplines and practitioners claiming success in treating fibromyalgia. And with the many different theories floating around regarding the cause of fibromyalgia, many different disciplines can back their approach to a proposed mode of onset. Add this to the fact that approximately 1 in 50 women suffer from this condition, and you have a very marketable condition for many. There is a reason that lyrica and cymbalta (medications), which have been around for a long time suddenly sought approval for treating fibromyalgia and are now considered fibromyalgia medications. It's big business.
Q. How much success is "some degree"?
Dr. Rock: Unfortunately, most single-disciplinary approaches to treating fibromyalgia, including medications experience only a 20-30% improvement, and that improvement is short-lived. The truth is there is not a magic bullet or simple procedure that can rid one of fibromyalgia. Fibromyalgia is a very complex condition and requires complex, multi-disciplinary treatment programs.
Q. What is the cause of fibromyalgia?
Dr. Rock: Fibromyalgia has several different causes. Our research clearly shows that fibromyalgia needs to be categorized into 4 primary subtypes, which are based on 4 primary modes of onset of fibromyalgia. The four subtypes of fibromyalgia are infectious (example, lymes or herpes), central nervous system miscommunication, stress induced, and toxic exposure or chemical sensitivity induced fibromyalgia. Ultimately, the consequence of these four causes is a disruption in the neuroendocrine system, mitochondrial dysfunction, tissue hypoxia, and a host of other physiological effects. This creates the symptoms of fibromyalgia. Many of the causal theories out there describe a symptom of fibromyalgia rather than a cause.
Q. What is the best treatment for fibromyalgia?
Dr. Rock: The best treatment is a multifaceted approach. There are a few staples that should be a part of all fibromyalgia treatment plans. The three treatments that are in all of our plans are oxygen through a hyperbaric oxygen chamber (oral and nasal oxygen are not nearly as effective), IV treatments, and neuroendocrine balancing. For most fibromyalgia sufferers, this combination alone will dramatically help and is long lasting. Most of our programs also utilize various other treatments such as clinical nutrition programs, chiropractic, physical therapy, massage, acupuncture, and other modalities. The most important thing to consider when seeking treatment for fibromyalgia is that all the treatments must be performed at the same time. Many fibromyalgia sufferers try only one type of treatment at a time and don't see results. The treatments must be carefully considered and combined as needed. For example, IV treatments alone have only short-lived effects, but when you combine the IV treatment with hyperbaric, the two work together.
Q. How do fibromyalgia sufferers find these treatments?
Dr. Rock: That's the tough part. Very few facilities have all the treatments required to successfully treat fibromyalgia. In most major cities, one can find all of the necessary treatments. It is likely that the patient will have to jump from clinic to clinic to undergo the necessary combination of treatments. This can get expensive. It's because of this that FCA was formed. There is a need for a facility that has all of the most proven fibromyalgia treatments in one place, along with a team of fibromyalgia experts. If people are having trouble knowing what treatments they should be undergoing and how to find them, we at FCA-Colorado do phone consultations in which we will send detailed questionnaires and go through a detailed history over the phone, then direct the patient to a clinic to undergo specific tests. The test results are then sent to us and we can formulate a plan of attack for the patient and help them find facilities to use.
Q. What should fibromyalgia sufferers look out for when assessing a particular provider's care?
Dr. Rock: I think the most important thing to look out for is when a provider attributes all fibromyalgia cases to a single cause. If a provider is treating all fibromyalgia cases the same, they likely do not have a great success rate. Other red flags for me would be a single medicine, supplement, or juice. There are a lot of claims out there regarding these three things. I don't mean to say these are bad things; they just aren't likely to be the answer you are looking for.
Q. What are some important questions to ask a provider during a fibromyalgia treatment consultation.
Dr. Rock: It is important to find out how the provider treats fibromyalgia and what their realistic expectations are following treatment. Make sure that their expectations match yours. Make sure to ask about their experience treating fibromyalgia. Providers that do not see a lot of fibromyalgia patients likely do not fully understand what you are going through and may make mistakes, such as being too aggressive in treatment. It is also important that if you are consulting with a solo practitioner to make sure they are willing to work with and communicate with other providers.
Q. Should testing be performed for fibromyalgia?
Dr. Rock: Absolutely, even though a specific test for fibromyalgia does not exist, testing is important. It exhausts other possibilities and can lead you in the right direction for treatment. Testing should be performed based on a detailed history. At FCA, we take a very detailed history and have the patient complete an extremely detailed fibromyalgia questionnaire. The purpose of the history and questionnaire is to lead us in the right direction. We then test appropriately. Approximately 35-40% of our patients have an underlying condition that is either causing their symptoms or complicating the symptoms. Common tests that we order are infectious agent tests, x-rays, MRI's, food allergy tests, heavy metals, endocrine tests, and many others in addition to a few regular tests.
Q. What types of providers should be on everyone's fibromyalgia team?
Dr. Rock: The first priority in forming your fibromyalgia management team should be to find a doctor to manage the entire case. Important qualities should be a deep understanding of fibromyalgia and the willingness and open-mindedness to work with other providers. Based on my experience, your best bet in finding such a doctor is to look for a naturopathic doctor. Naturopathic doctors are the best equipped to treat fibromyalgia, because not only do they have a doctors education, but they also are experts in nutrition and healthy living. Other important members are a medical doctor and chiropractor. Chiropractic has an excellent track record in reducing the symptoms of fibromyalgia. Medicine is required for many aspects of care. I would encourage people to find a conservative MD, one that is not quick to prescribe heavy hitting drugs, such as narcotics. These do not do much for fibromyalgia in the long run, as they do not address the cause, and in fact can actually worsen symptoms after long-term use. Aside from those three (naturopath, MD, and chiropractor) one should try physical therapy, massage, and acupuncture. The results of these three vary for each individual. Find which works best for you. The final member of your team should be a mental health professional or life coach. It is important that this person help empower you. We use a life coach that specializes in purpose driven living. This approach provides meaning to one's life and motivates them to pursue the meaning. It is very powerful, and our clinical research shows this to be a very effective approach to treating the mental side-effects of fibromyalgia.
Q. Do you have any final recommendations for our readers?
Dr. Rock: Don't lose hope. Fibromyalgia can be successfully treated. Find providers that understand fibromyalgia and how to best treat it. Open the communication lines between the providers and comply with recommendations. Be patient, there is not a quick fix for fibromyalgia. Our treatment programs usually last 4-6 months, and then include a 6-month follow-up period to ensure lasting results. Stay diligent and keep fighting.
Dr. Rock can be reached at can be reached via e-mail at fcaboulder@gmail.com. For more information about Fibromyalgia Centers of America-Colorado, visit their website at www.fcaboulder.com.