Dr. Andrea Chadwick, MD, MSc, FASA, is chronic pain physician specializing in fibromyalgia care and Medical Director of Swing Care. In this Q&A, we discuss how to approach a fibromyalgia diagnosis, the diagnostic criteria, and other questions that come up when meeting with your doctor.
How did you get started treating fibromyalgia?
I’ve been a chronic pain physician now for a little over 10 years, but specifically focusing on fibromyalgia care for the past six years or so. I went to medical school at the University of Kansas, and then went to the University of California, Los Angeles, where I completed a residency in anesthesiology. Then did a combined fellowship and research degree at UCLA as well. That fellowship was in pain medicine, and then I stayed on to practice there for a couple years before I found myself back in Kansas.
Not everyone in traditional pain management feels comfortable treating fibromyalgia in the long-term. But for me, my approach to treating fibromyalgia has really focused on creating that positive relationship between patient and provider, and empowering patients to embrace their best selves and move forward in their life with fibromyalgia.
What exactly is fibromyalgia?
Fibromyalgia is a chronic pain disorder. What we know from research is that fibromyalgia generally is caused by an overactive or hyper-reactive central nervous system; the central nervous system is comprised of the brain and the spinal cord. So when you look at the mechanisms that cause the symptoms of fibromyalgia, most of them are occurring in that central nervous system, both in how it’s developed and then maintained.
People often ask me: Do I have fibromyalgia, yes or no? And what I try to explain, not only to patients, but to clinicians and providers alike, is that: Yes, you can have a fibromyalgia diagnosis and it comes from a set of criteria. But for those of us who research and treat fibromyalgia, it’s much more of a spectrum in terms of how people experience it.
Some people have more evidence of chronic widespread pain, which is one of the diagnostic criteria. But many people have additional symptoms that may make their overall picture of fibromyalgia much more severe. Those can be things like stress, cognitive difficulties (known as fibro fog to those in the community), or fatigue, to the point where people feel like even if they sleep, they aren’t refreshed.
How can people talk with their doctor about a fibromyalgia diagnosis?
Fibromyalgia currently has some accepted diagnostic criteria that you can find online. It’s a simple self-report survey that was originally published in 2010, but has recently undergone some revisions.
The gist of the survey includes a body map where you check off areas of the body where you might have pain. Then there is an associated set of questions that determine the severity of those additional symptoms that we talked about.
In my opinion, any provider can help aid in this diagnosis using that diagnostic criteria, because it’s really simple for a patient to fill out and it’s just as simple for a clinician to score it. Should the score meet criteria for a fibromyalgia diagnosis, then you can work towards coming up with a treatment plan.
What are some of the toughest questions you get from your patients?
A big one is, “Hey, I’ve been told it’s in my head that this is a condition that’s just in my head, and if I just exercise, I’ll be better. Is that true?” Those are the hardest questions to hear because what that signifies to me is that someone doesn’t feel heard or validated, or they just generally feel invisible or not seen by the medical community. Hearing that question, especially if it comes from that patient’s loved one or support network, is one of the toughest ones to hear.
Outside of that, the hardest part is just finding the right personalized treatment for people. Patients say, “I’ve tried X, Y, Z amount of pharmacologic therapies. I tried to do physical therapy, but it made my pain worse.” Patients can really struggle to find that treatment regimen that works for them. Those are hard questions because, as physicians and clinicians, we all want to make our patients better and help them live their best lives. And I think often patients feel a bit discarded when providers or clinicians don’t try to partner with them to figure out the strategy that works for someone on a personalized basis.
At Swing Care, our treatment paradigm is that we are here to partner with patients using our knowledge of the mechanisms and the science behind fibromyalgia and fibromyalgia treatments. But we also are really taking into account that lived experience and expertise that the patient has in their own condition, and try to marry the two of those and find that ability to come towards a treatment path combines that experience with our medical and scientific knowledge of the condition. We’re hoping to do personalized care for patients because that’s the best care there is.