What’s the Prognosis?
What’s the Prognosis?
When patients are diagnosed with fibromyalgia, one of their first questions to us relates to its outcome. “Is there hope, doc?” and “Will the pain ever go away?” are two of the more common queries we hear. Unfortunately, few surveys have addressed this issue, and some have arrived at contradictory conclusions. This chapter will try to put these studies in their proper perspective. Yes, there is hope! When discomfort is limited to a specific region of the body and is not widespread, the outlook for long-term relief of pain is usually quite good. With local physical measures, injections, emotional support, and anti-inflammatory and analgesic medication, as well as instruction in proper body mechanics, over 75 percent of regional myofascial pain syndrome patients have substantial pain relief within two–three years. Unfortunately, there is little middle ground. For example, in an 18-year analysis of 53 patients with low back pain followed by musculoskeletal specialists, 25 percent ultimately developed fibromyalgia. Therefore, we believe that myofascial pain should not be shrugged off or given short shrift. A problem that is addressed early and effectively saves patients, health plans, and society money. Also ameliorated are the heartaches of patients and those close to them. Improved productivity promotes a feeling of relief, as well as a better quality of life. When a practitioner prescribes Advil and says that this is all that can be done for TMJ dysfunction syndrome, it is penny wise but pound foolish. The outcome of fibromyalgia depends on who sees the patient and calls the shots. For example, in one report that tracked family practitioners, internists, or other primary care physicians familiar with fibromyalgia’s diagnosis and management, 24 percent of patients were in remission at two years and 47 percent no longer met the ACR criteria for the syndrome. This implies that early intervention by a knowledgeable community physician is the first line of therapy. Children with fibromyalgia also have a favorable outcome. In the largest study to date, symptoms resolved in 73 percent within two years of diagnosis. The outlook in tertiary care settings is not as rosy. Once the symptoms and signs of the syndrome are serious enough to warrant referral to an academically oriented rheumatologist who is involved in fibromyalgia research, improvement is common but recovery rare.
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