Assessing impaired balance in fibromyalgia

[WiscGuy]

I have seen mention made here of fibromyalgia. I thought there might therefore be interest in the brief article linked here:

consultantlive.com/view/new...

[Nackapan]

Interesting. So many conditions including PA / b12 deficiency would also struggle with these tests .

As can cause vertigo

Tinnitus

Balance issues

My daughter was misdiagnosed with fibromyalgia.

Which halted further Investigations until I blocked her discharge from hospital on the grounds she couldnt get to the bathroom opposite her bed in her 20s and with a very strong will.

Balance issues and passing out / fits.

Nothing had changed since being admitted 😕

That was the first time they tested B12 and folate. ( in her boots and b12 Injections started)

In hospital given in the outer thigh

Further testing was done in the hospital.

Fibromyalgia was eventually removed from her notes as were Mental health/ depression mentioned at every consult which would annoyingly make hef cry in exasperation/ frustration/ anger.

Adding to their misdiagnosis !

I think all these tests are a good tool .

Results noted

I don't think conclusive for one single condition though.

Wouldn't like doing those now !!

[Star13]

ohhhh! These sort of studies make me soooo cross. I don’t have Fibromyalgia and I probably could not do that test. So they get a group of women already labelled with it and ask them to do the test. They fail so they say that it’s a reliable test for Fibromyalgia! What rubbish! I wonder how those poor women were first “diagnosed” in the first place!!!

There are so many reasons why people have poor balance and gait but to use this test to stick them in the bucket of Fibro is very dangerous. It is the lazy doctors bucket as in most cases if they look properly they will find the underlying condition that they should be treating!

[Technoid in reply to Star13]

I don't think the study is saying that this test can be used to diagnose Fibromyalgia. Rather, as you say, they started with a population that already had a fibromyalgia diagnosis. The purpose of the study seems to have been purely to assess whether this test was reliable or useful within an already diagnosed population. The full conclusion reads:

"The results obtained from this study show that the 3MBWT is a reliable tool under the single and dual-task conditions in women with FM. It shows higher reliability values when time is taken using a Chronopic. This test also shows high concurrent validity with the TUG test, and its performance is related to the impact of the disease. These results may help clinicians and researchers in the assessment of balance and functional mobility and to interpret the effect of interventions in this population."

Notice they're really focused on whether or not the test is reliable in the subject population. There is no control group or inclusion of individuals with balance impairments that might not be due to Fibromyalgia. This is not an accident or mistake as they're not trying to assess whether this test can be used to conclusively diagnose fibromyalgia, they just want to know if the test is reliable (no false negatives) and useful, in a population that already has diagnosed fibromyalgia.

Fibromyalgia is a diagnosis of exclusion. To justify a fibromyalgia diagnosis, other likely causes would have to be ruled out such as B12 deficiency, Multiple Sclerosis, Diabetic Neuropathy etc etc.

I dont think the researchers are unaware of this. It's just not the object of their study which has a much narrower focus. The ultimate usefulness is only as they say to "help clinicians and researchers in the assessment of balance and functional mobility and to interpret the effect of interventions in this population." The key phrase here is "in this population". They are not making any statements about the usefulness of this test to diagnose Fibromyalgia in the first place, instead they only conclude it has usefulness within an already diagnosed population to assess balance and functional mobility.

But if is true that lazy doctors sometimes diagnose fibromyalgia when they have not excluded other causes or are unable to believe a serious B12 deficiency is present or could cause the observed symptoms. Personally, I think Fibromyalgia is not a very useful diagnosis and most people with a fibromyalgia diagnosis should keep looking for a better explanation of their symptoms as fibromyalgia has very little explanatory power and little or no effective treatments whereas alternate diagnosis usually do. It is my non-medical, non-professional opinion that a significant proportion of those diagnosed with fibromyalgia are misdiagnosed and actually have some other condition that is not being recognized and thus not effectively treated.

The page has a really comprehensive guide to making Fibromyalgia diagnosis:rcplondon.ac.uk/guidelines-...

[Star13 in reply to Technoid]

 It is my non-medical, non-professional opinion that a significant proportion of those diagnosed with fibromyalgia are misdiagnosed and actually have some other condition that is not being recognized and thus not effectively treated.

Totally agree! Not only does the misdiagnosis mean they are not effectively treated but it can cause serious even life threatening consequences (as in my case) when that misdiagnosis misses serious and life threatening diseases which if a Doctor does his job, should be picked up.

The diagnostic criteria for FM is just not adequate in a busy, often money strapped and time short environment. Not only that GPs are often confused with guidelines that keep changing. This is often the case with conditions where there is no definitive test.

Unless and until there is more respect to this so called diagnosis, which at the moment is more a group of symptoms that anyone of them “could” be associated with something else, then you risk being labelled with a condition that labels you and does more harm than good.

[Nackapan in reply to Star13]

Totally agree

[Marz in reply to Technoid]

I was diagnosed with FM in the UK by a Rheumatologist in 2000 and with Auto-immune thyroid disease in 2005. Along with Low B12 and VitD. I was diagnosed in Crete with FULL thyroid testing to include anti-bodies. In the UK I would have remained undiagnosed with Hashi's due to inadequate testing. This would seem to be the case with many FM sufferers as only the TSH is tested - a pituitary hormone - ignoring T4 & T3 and antibodies. This was my personal experience from reading posts on the Fibro Forum here on HU. I was eventually banned for suggesting more detailed testing could be helpful .... a sad state of affairs 😢

[Star13 in reply to Marz]

Snap! Funny how a forum which is supposed to support people are quick to shut down and shut out questions!🤨

[Sleepybunny in reply to Technoid]

"Fibromyalgia is a diagnosis of exclusion. "

I agree it should be, shame the GPs I saw didn't know that.

"It is my non-medical, non-professional opinion that a significant proportion of those diagnosed with fibromyalgia are misdiagnosed"

It's also mine.....

[Littlelodge123 in reply to Sleepybunny]

completely agree

[Shogie in reply to Star13]

Hello

My GP at one point said perhaps I ought to be referred to a Fibromyalgia specialist - to which I replied - (a bit sarcastically) please do. My symptoms disappear for a week or so after B12. That's obviously the cure for fibromyalgia! Shogie

[Star13 in reply to Shogie]

😂😂

[Cherylclaire Forum Support]

I'm not even sure that I would consider a syndrome as a diagnosis at all, and I believe the Oxford English Dictionary agrees:

Syndrome: Group of concurrent symptoms of a disease.

Diagnosis: the identification of a disease by means of a patient's symptoms.

Most syndromes seem to be identified only by elimination of all other known possibilities, diseases that can be diagnosed.

So a syndrome is perhaps better described as "a group of symptoms that together have an unidentified cause."

This might encourage GPs or consultants to keep looking beyond a syndrome as a definitive diagnosis.

I might have Irritable Bowel Syndrome (IBS) and burning tongue syndrome - or these may both turn out to be irreversible remaining B12 deficiency symptoms, alongside others that are less reliably frequent. IBS was suggested by a seemingly supportive gastroenterologist in a report after a lengthy discussion during which he told me to return to my GP as soon as B12 symptoms returned rather than wait 3 months and did not even mention IBS to me at all - and the next concluded that IBS was my "diagnosis" after a five minute chat. At least the last one ruled out Coeliac disease before a third IBS "diagnosis" and had the decency to acknowledge that it did not explain any of my other symptoms.

Why did I have three gastroenterology appointments ? Because my GP had IBS herself, and knew that this was neither a useful diagnosis for me - or a reliable one anyway, without the exclusion of all other possible conditions or taking other issues into account. So she sent me to three different gastroenterologists, hoping for a better explanation.

I wouldn't be happy with fibromyalgia as a diagnosis with balance issues as an accompanying symptom either. The article is of interest because it demonstrates a possible link between two symptoms - perhaps with further research, eventual proof that both of these can occur in connection with B12 deficiency.

Not, granted, the long-awaited breakthrough we are after, but welcome additions to often rather paltry B12 deficiency symptoms lists that lead to medical professionals believing that "tiredness" just about covers it.