Long-term pain requires diagnosis

DEAR DR. GOTT: I read your article in the newspaper about fibromyalgia and was very interested. My 77-year-old husband just had his physical. Everything was great, and he is a picture of health.

He wonders how this can be when he complains to the doctor every time about how he hurts so much. He suffers from all the things you mentioned in the article that go with fibromyalgia, yet no test or doctor can tell him this is what he is suffering from. Everything always comes back normal. They just tell him that there is no test for this disease and no cure.

His life is miserable. He is always tired regardless of how much sleep and rest he gets.

He has tried chiropractic treatments with no success. I also put him on a special diet I read about in a book that said it was clinically proven to fight inflammation, which is the hidden cause of weight gain and chronic disease. It didn’t help his pain or fatigue, but he did lose 12 pounds.

We don’t know what to do next. He doesn’t want to try anything else and doesn’t want to waste money on something that won’t work.

Some background information is that he has had three back surgeries. The first was for spinal stenosis, the second was to put in a plate, and the third was to remove it again because it was thought the screws might have been the cause of his discomfort. This is a separate issue, but his back still aches all the time, so he is now taking four Vicodin a day and has done so for about seven years. He is also taking Accupril once a day and hydrochlorothiazide for high blood pressure.

DEAR READER: Your husband’s physicians are correct in saying that there is no test that will diagnose fibromyalgia. There is also no cure, and treatment can often be difficult.     

First, I would like to point out that your husband already has a back problem. If this has worsened,  his discomfort could be directly related. Pain can also wear the body out very quickly, leading to persistent fatigue.

Next, your husband is taking two blood-pressure medications. Accupril carries the side effects of both back and joint pain. The hydrochlorothiazide also carries the side effect of generalized weakness. This should be looked into, because if his pain and fatigue developed after starting one or both of these medications, you may have the answer.

Finally, long-term narcotic use should be discouraged whenever possible. It can cause dependency and, over time, a resistance to the narcotic effect can make the medication less effective in relieving pain, necessitating increased dosages. If your husband has built up a tolerance, the Vicodin won’t relieve the pain as effectively.

I suggest your husband ask for a referral to a rheumatologist. Perhaps it is due to arthritis. From your letter, I noticed that you live in Pennsylvania, which has increasing cases of Lyme disease and other tick-borne illnesses. He should undergo testing and examination to determine whether this is a possibility. If no cause can be found, your husband may then benefit from physical therapy or a pain clinic.

Peter Gott practiced medicine in Lakeville for 40 years.