Interview with Dr Susan Wong, MD

Philippe: I am happy to welcome Dr. Susan Wong. I met her last year in a conference on fibromyalgia. She has now retired but keeps a keen interest in fibromyalgia.



Phil: Do you believe in fibromyalgia? Some doctors still don't believe in it and even some who thought it existed have changed their mind.



Dr SW: Yes, I know that Dr Wolfe, who participated in the "classical definition" in 1990, seems to have changed his mind. I think the definition has created a nightmare! It imposes that any fibromyalgia sufferer has to be in a very chronic stage and difficult to treat before being given the proper diagnosis. In the meantime, the fibromyalgia patient has been suffering from many other problems and is starting to have doubts. The same happens to the family, friends and doctors! Moreover, this definition concentrates almost exclusively on the pain factor. This has attracted the false theory of fibromyalgia being a Central Pain.


Phil: That was my next question! Do you think this Central Pain theory, the brain
theory, is wrong?



Dr SW: Well, this theory is based on changes in brain activities and regional cerebral blood flows that are common to all chronic pains. I defy any neuro-radiologist to make the diagnosis of fibromyalgia from those images. They are just not specific to fibromyalgia! All we can say from those images is that fibromyalgia is one of the chronic pain, but we knew that already! However, if the Central Pain theory is wrong (there is no central nervous system lesion), the images do give credential to fibromyalgia being a real disease. But we knew that one too!


Phil: If you say that the "classical diagnosis" is too late, what should we use?



Dr SW: I use a probability diagnosis very similar to the one you have in your website (http://www.fibromyalgia-information-relief.com/fibromyalgia-test.html). Instead of only considering the pain, I consider the whole body and the different functions. When I had groups of fibromyalgia patients, I have always been very attentive to the fact that they never had all the symptoms and that many were surprised by some of their fellow sufferers complaints. I have never seen anyone saying, “I have everything you complain of”. Every one of them is an individual with different problems, even if they are all related to fibromyalgia.

Hysteria and hypochondria are never part of fibromyalgia but in very rare cases. The same happens with psychological profile: they do not have any specific psychological profile! All that psycho babbling is exactly that: bull dust!


Phil: What’s your opinion about the fact that the FDA has recognised 3 medications to treat fibromyalgia and the European Council for Health has refused them?



Dr SW: For many years, long before they were recognized, I have used tricyclic antidepressants and anti-epileptics in my armamentarium against chronic pain. The success has always been limited and tends to be short lived. It does not mean that they should not be used. But they should be used with caution and with careful follow-up. There is no advantage of having no effect on the pain and getting side effects from the medication!

But suddenly we have seen appearing a new theory and at the same time pharmaceutical companies’ reps appear with free lunches, paid for conferences etc... And what they present to us is a very dubious small series of publications on their new drugs. Most of them are 8 to 12 weeks long when we are talking about a life disease. The longest that I know of is 6 months long and shows a very narrow difference in the outcome between medication and placebo. Whenever we try discussing this aspect, we are at best ignored. I have done a review of the published articles and I cannot find any justification for prolonged use except in those rare patients where the effect is positive. But to add misery from side effects is not acceptable. A frank and opened discussion with the patient does sort it out. The risk-benefit ratio is so narrow that a full informed consent is necessary.


Phil: So, can you give us a summary of your treatment of fibromyalgia?



Dr SW: A summary is difficult because every individual is different. I would say that there is a basic treatment that everyone should get and individual additions.

The basic treatment includes: magnesium supplement, vitamin B6 supplement, diet, relaxation techniques, avoidance of stress, simple exercises, electromagnetic stimulation.

Additions depend on individual problems such as symptoms flare up, necessity to increase the speed of results or needs for special support. Obviously, we must not forget the painkillers. The pain needs treatment! By the way, the effect of "soft morphinics" such as codeine, tramadol or buprenorphine is too good to be a so-called Central Pain! Central Pain requires huge amounts of morphine. This is another proof against this theory.


Phil: Thanks for this perfect summary! What’s your vision for the future?



Dr SW: We really need the same amount of investment in safe and non invasive techniques similar to the investment made by pharmaceutical companies that are allowed to introduce unsafe drugs of clinically dubious interest. The justified outcry from fibromyalgia patients must not be met by pseudo-magic pills. Lets make a pledge for the incoming fibromyalgia day: we just don't need a new carburator or a new fuel. We need a full car on a good road to recovery and that journey must be efficient and safe!


Phil: Thank you for your precious time!