Lyrica

There is now a drug for the condition known as fibromyalgia. Lyrica is being prescribed to treat the widespread, unpredictable body pain that characterizes this condition. The headline of the New York Times article is blunt: Drug Approved. Is Disease Real? Fibromyalgia does not possess the characteristics usually required to call something a "disease" in our culture. So it is with some reluctance that Lyrica has been approved.

It is indeed interesting that there is a specific drug now. I was sorry the article only said a little bit about what kind of drug it is, and nothing about how it is used or what the results of early trials were. But the more important issue is the ongoing "is it real" debate, and more specifically, how to deal with people who claim to have severe pain, the cause of which cannot be found by any known medical test. The above article has a decent summary of the main views.

I am coming to see that the challenge about this so-called debate is that both sides are right-- and both sides are wrong. It is indeed true that people who get lots of attention for being in pain are more likely to become dependent on having pain and to begin noticing every ache that other people would simply live with. And it is also true that people in pain who are ignored or dismissed will be more likely to spiral down into having more and more pain, often becoming depressed. So the formula seems to be: Ignore it, and it gets worse. Indulge it, and it gets worse. Both are true.

In the West, we tend not to see alternatives to indulging or ignoring. For example, we are routinely told that the only options for dealing with emotions are to "let them out" (ie, loudly express them) or to "suppress" them. We know suppression is bad, so we assume that expression is good. But usually that expression takes the form of indulgence. Do you know anyone who routinely expresses anger who has, as a direct result, become less angry in the long run? I don't -- mostly these people keep the same temperament, only momentarily blowing off the steam. But people who repress their anger of course don't fare any better.

What we fail to realize is that there are other options. For instance, simply noticing and letting things be, with neither expression nor suppression. I wouldn't go so far as to say that this is always the best option or even that it reduces pain. But I do know that there are options for handling both physical pain and difficult emotions besides the usual two that we acknowledge. The heart of the "debate" around fibromyalgia is whether it is better to "coddle" people who have inexplicable pain, or to use "tough love" to get them to shape up -- basically, expression or repression. Given that this is a nonexistent dilemma, I see the whole issue as largely misunderstood by both doctors and patients. When you are asking the wrong questions and barking up the wrong trees, there is really no way to make progress.

Nonetheless, I hope that Lyrica helps some people who have been diagnosed, either directly by controlling their pain or more subtly by providing enough psychological support that they can find other options for themselves. Being in that kind of pain is harmful for everyone, not just the person experiencing it. I know.