Comorbidity

Comorbidity is a tricky thing.  Put simply, comorbidity is when a patient has more than one disease, syndrome, condition at the same time.  For people with fibromyalgia, comorbidity becomes a confounding factor.  Which comes first?  The fibromyalgia or the other thing?  Or does fibromyalgia develop when another condition is not properly managed?  If the other condition has a cure or a good way to manage it, does that help with fibromyalgia symptoms?  Will curing the other problem or problems also cure fibro? Where exactly is the boundary between fibro symptoms and the symptoms of other (possibly related) conditions?  So very many questions.

Setting aside another question I have toyed with but which I haven’t really looked into yet (are there certain specific comorbid conditions for fibro patients and if so, if you look at the origins of those conditions, do you find the origins of fibromyalgia?), I found an article by Rivera and Vallejo in Rheumatology, “Fibromyalgia Is Associated to Receiving Chronic Medications Beyond Appropriateness: A Cross-Sectional Study,” (see library) which looks at people with fibromyalgia plus comorbid conditions and how medications are prescribed.  There is a startling bottom line.

  1. People with fibromyalgia plus comorbid conditions receive a greater number of medications AND they are prescribed for a longer period of time.
  2. People without fibromyalgia but without comorbid conditions receive fewer medications for a shorter period of time.
  3. People who have fibromyalgia symptoms but have not been diagnosed with fibromyalgia and have comorbid conditions receive similar pharmaceutical care as people without fibromyalgia.

This is not an indication that doctors are just throwing pills at people with fibromyalgia, but it could be an indication that they are just flat out stumped and hope that by “fixing” other conditions they can give some relief to patients who are suffering.  It could also be an indication of the pressure that physicians may feel from the fibro patients to get relief for their pain.

The problem with meds is that they are like a give-and-take method for treating anything. Yes, there may be some relief for some conditions.  At the same time, they can cause other problems.  For example, I tried Lyrica for a short time because it is supposed to help both pain and depression.  The effect on my pain levels was minimal, as was relief for depression.  Without knowing it, I was living in a cloud.  I didn’t realize I wasn’t thinking clearly until I went off the Lyrica.  The pain levels went up more than I expected because I couldn’t even really judge its effect on pain because my mind was so muddled.  But as soon as I walked out of the fog and could think again, I could manage the pain better on my own.

It’s not just meds for fibro that are give-and-take.  I was recently on a course of antibiotics for a staph infection that gave me heartburn, a swollen and painful esophagus that made it difficult to swallow.  It felt like I wasn’t chewing, and the food was tearing me up as it went down.  Could I stop taking it?  Nope, but if it wasn’t a staph infection I probably would have – I’ve stubbornly stopped antibiotics that made me sicker than the condition I was being treated for.  But I only had to take this one for a week.  If I take a med for fibro, it’s going to be for an extended period of time.  I have to weigh those pros and cons carefully and make my own choice.

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