Let us together rewrite a part of Rheumatology.

I am working in Pain Management since last twenty years. Not only that I have vast and valuable experience in the treatment of Pain syndromes but I have devised new modalities and established new algorithm for the treatment of Osteo-Arthritis Knee Joint, Chronic low back Pain and other major myalgic problems. My work has given new concepts that are supplemented by clinical results. Our findings are:







Looking at the present status of the diagnosis and treatment of this condition it can be presumed that the subject of fibromyalgia is yet open to discussion and needs further probing. It would only be possible to find a treatment once we are able to settle the parameters and etiology of this disease. It is time that we shall discuss this condition from a different perspective. The only diagnostic criterion available is the 18 painful sites on the body that have been indicated. 11 among these 18 points are supposed to be tender so as to term the patient as a case of fibromyalgia.

As we look towards these tender points from a different perspective for a while, we see that six among these paired points are well known and can be contributed to an underlying ailment, if unmasked by the newly explained technique of "Unmasking and treating the underlying Condition".

Three of the points in the neck are the points most commonly found in Pain Neck ( See Cervical Spondylosis). Unless unmasked it is usual to find multiple tender points. It is only after unmasking, that the points would be tapered down to a few.

Another two points correspond, one to the tender spot of Sacro-ileitis and the second to the tender medial point of the Pain Knee (see OA Knee Joint and Low back pain chronic or acute). These are two points most frequently unmasked and localized at exactly the same location. However it is not unusual that as the pain problem starts getting chronic it cause the development of many trigger spots that are secondary to the primary problem. The trigger spot on the lateral side of the Gluteal fold as shown in the ACR criteria of Fibromyalgia could be an extension of the chronic painful points of Sacro-ileitis as it gradually may develop Sciatica (Referred pain). Similarly the points on the front of Neck may be caused by the chronic neck pain.

We shall not forget that Fibromyalgia is a chronic condition and to finally diagnose it as such would require a long time. It may not be possible to label it fibromyalgia before such widespread involvement of musculoskeletal system has actually happened. Therefore, doctors often have to rule out other potential causes of these symptoms before making a diagnosis of fibromyalgia. Also it is evident that chronic low back pain and pain neck (Cervical spondylosis) had remained untreatable under the conventional treatment modalities, and it has been only possible after this newly explained technique that we have been able to suggest treatment alg resulting in early recovery in these longstanding chronic cases. So there is a possibility that the two conditions of pain neck and lumbago-sciatica get aggravated to form an unmanageable condition that is termed as Fibro-myalgia.

Syed Zahid Hussain Bokhari, Latest on Osteoarthritis and Myalgia: The Technique of "Unmasking and treating the underlying problem. ISBN: 978-3-8454-3712-5 " LAP LAMBERT Academic Publishing, 2011