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Where's Waldo and Carmen Sandiego have Fibromyalgia (and a love child on Epstein Island)

·1652 words·8 mins
The Wonderful Public
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So a thing happened:

I want to write on shit people will read, so once in a while I will poll my twitter followers on what sorta shit they wanna see me rant about. The AngryCall(tm) went out:

Well, I didnt really expect this in response. Thanks interest_with!

The great warning to all the folks who look for shit to be offended about #

It fucking kills me that I have to write the following, but people now days are fucking pussies:

I’m painting with a broad brush here, don’t get all butt-hurt and attempt to justify how you’re different. We are all different in our unique and special way. Except me, I’m fucking awesome.

If you are the type to get really offended and ’literally shaking’ as you read this. Stop right now, close this page. Go outside, get some sunshine, and come back when you can act like an adult and take some razzing. Also come to terms that this is the internet thereby nobody really gives an honest fuck if you’re offended. You are in charge of your own feelings not I nor anyone else.

If you get horribly offended by someone’s (who has angry in their name) opinion presented as a joke then go look at yourself in the mirror, imagine yourself in clown makeup, and contemplate if you’re really offended, or are offended because you need to impress internet strangers for sympathy likes.

You’ve been warned, dont bitch just laugh.

What the fuck happened to Fibromyalgia? #

It wasn’t until that twitter response that make me realize that the whole pandemic of fibromyalgia just sorta stopped. Its just silently bowed out and nobody brings it up again.

Now am I saying fibromyalgia doesn’t or never existed? Well…… I would be a dick if I said yes, so I’m going to say maybe.

Lets look at the facts before you all decide to burn my house down (Oh wait, you’re in too much pain/too loaded on narcs to do that) or write a 5000 word essay justifying your condition (ha! turned comments off). You’ll probably just write an angry post about me on reddit and try to cancel me for MiSinFormaTIon! Its called having an opinion, and just because it doesn’t agree with yours doesn’t mean its wrong, its just a different viewpoint. I’m not an expert, i’m not an authority, i’m just a random pharmacist on the internet who swears a lot and can’t spell worth shit. Novel fucking concept I know.

Facts (brace yourself, hurt feelings incoming) #

Sidenote: These are facts1, now if you disagree with the facts that’s great, but you can’t in the same breath scream ’trust the science’ for one aspect that you agree with and deny science when you don’t agree.

  • Fibromyalgia is entirely subjective.
    • There are no concrete labs to confirm nor deny the diagnosis. You say how you feel, and when the primary treatment are narcotics, well, fuck I got 10/10 pain writing this right now.
    • Fibromyalgia was a catchall diagnosis when the pain/symptoms have been ruled out by any other sorta diagnostic test, that subjective vagueness makes my butthole pucker when I’m counting out 240 norco-10.
  • The primary treatment for fibro was a opioid, a benzo, and a muscle relaxer.
    • In pharmacy we called those the ‘Holy Trinity" that just by filling them (and submitting it to PDMP like we’re forced to) we’re put on a list.
    • Fill enough holy trinity patients and people in suits start coming in flashing ID and telling nobody to leave and if the PIC or manager is there.
  • Women are more likely to get it than men
    • Which is interesting because you would think a musculoskeletal condition would impact men more than women just due to higher muscle mass.
    • On the other end women are more likely to go to the doctors and complain about shit that men would just shrug off as no big deal.
  • There is a questionnaire2 to help diagnose it.
    • Now looking at the questions they ask, I could check every single box at some point within that time period. Yeah my knees/feet/back hurt, I cant remember shit, I have a lot of shit going on so I cant sleep, etc. Those are symptoms of getting fucking old - OR MAYBE I HAVE FIBRO!!
  • A big complain is ‘fibrofog’, which is you just mentally aren’t all there.
    • Considering what the old treatment for Fibro was I think I can safely say “fucking duh you were higher than a SpaceX shuttle with Cheech, Chong, and Snoop Dog at the helm”
  • Studies show that maybe affects 2-5% of the population, but it seems like my store (and probably others) saw it effect 85% of their patients.
    • Plot twist: Maybe patients lie to get narcotics? Maybe since there isn’t a concrete test all the provider has to go on is their word? Shocking! Unbelievable! I need to go write my congressman and inform them of this discovery!
  • The treatment for Fibromyalgia is a medication that gives you a physiological reward the higher the dose.
    • I mean do I need to actually expand on this? Its like a little kid pitching a fit because their parent will give them a treat for them to shut the fuck up. Eventually they pitch a fit just for the cookie until they actually believe the fake fit they are pitching.

So now that I’ve pissed off everyone on the internet in the circle jerk echo chamber of fibro:

Why I think it died out #

  • The DEA/State Boards/Medical Boards in an attempt to solve the “Opioid Crisis” (That they set the ball rolling on by treating pain as another vial sign) are hammering doctors and pharmacists for being ‘pill mills’. As a result, prescribers are really fucking leery on prescribing pain medication unless they have a solid charted diagnosis they can justify. Pharmacies are the same way, we want a solid diagnosis so when questions are asked, we can justify it.
    • So my state sends out little notices of Doctors who got their licenses yanked/probation/etc (so we can update our computer system). So me, being nosey decide to read the Accusations filed against the high-license numbers (ie: People who got their ticket ballpark when I did).
      • A more than significant number of those prescribers got dinged on overprescribing opioids to a patient that was diagnosed as Fibromyalgia upon initial visit
      • Due to the vagueness of the diagnosis, the chart notes were of course, vague. To the point of “I’m in pain I want narcotics” “Okay!”
      • Narcs were given, narcs “stopped” working, narc dose increased, repeat (until pt ODs, arrested for diversion, complained to the medical board when the prescriber cut them off, etc)
  • The diagnostic technology has increased where all the Fibro patients are now being treated for a quantitative medication condition. Meaning they had an undiagnosed condition that can be proven
    • No more of this subjective shit that left more questions than answers. It was to the point where it was “I’m in pain, i don’t know whats wrong with me gimme pain pills” and doctors would go “uh okay”
    • This is probably the real factor right here, which is good because now they can get treatment for something instead of just throwing norco-laced shit at the wall and seeing what sticks.
  • The fad just died.
    • You can’t get magical reddit internet points for having fibromyalgia and posting a 4000 word essay (notice how my examples get larger and larger) about how it impacts your life. Nobody really cares anymore; “yeah you have fibro, so?”
    • There are a TON new and trendy ailments you can say you have. That’s like going into a group and bragging on how Offspring is the best band in the world. Or how R-Kelly peeing on some underage chick is SO BIZARRE.
  • COVID-19 was just weaponized fibromyalgia and since people have gotten a form of immunity to it, its no longer relevant
    • I just made this up, but I think its pretty funny.
  • Everyone and their brother is on a GLP-1 Agonist, thereby they are losing weight and the fibromyalgia symptoms have decreased. Also gastric bypass surgeries are getting more and more common. Again, less stress on your joints = less pain. Nobel Prize here I come!
    • This one sounds funny, but overweight and fibromyalgia go hand in hand. That makes sense.
    • You notice how once they pulled PPA off the OTC decongestant market (for causing brain bleeds/strokes in women between 20-50 who were taking way over the max dose in an attempt to lose weight) the cases of Fibromyalgia went up? Pepperidge Farms remembers.
  • Chronic pain is getting out of the hands of the GP/PCP and into the hands of specialists.
    • Notice when pain management clinics started going full swing the number of cases of fibro stopped being mainstream? Hmmmm…. Its almost like they saw through all the bullshit cases and treated the legit cases with shit other than a truckload of narcotics!

Closing Thoughts #

Do we still have patients who bring in scripts for Fibromyalgia? Yes. However the amount of cases has dropped. I’m not the only pharmacist who has seen it (although I didn’t notice it until it was brought up).

Patients are being shifted away from the hard narcotics and more into the Lyrica (why is this even controlled? Gabapentin isn’t controlled in my state) realm which really benefits everyone except the people who were just using it to get loaded/pay their Hellcat payment.

Thank you for coming to my Ted Talk!

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016048/ ↩︎

  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016048/figure/DialoguesClinNeurosci-20-53-g001 ↩︎

The Angry Pharmacist
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The Angry Pharmacist
Started this site in 2005 out of frustration that pharmacy school does not prepare you for dealing with the ungrateful unwashed public. Was hugely popular until life called and I had to take a break. Now I try to provide low brow potty humor that applies to the pharmacy population at large. Except you clinical fucks, go play doctor with your white coats and snobby attitude.
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