The treatment for fibromyalgia varies according to the doctor administering it. Patients often wind up seeing a rheumatologist or a pain-management specialist, and the most common medical approach involves reducing the symptoms - widespread muscle or joint pain, weakness, burning sensations, extreme skin sensitivity and fevers - and increasing the patient's capacity for activity.

Dr. Edward Lubin, a pain-management specialist at Winter Haven's Gessler Clinic, said the most important element of his treatment comes at the beginning. Many patients arrive hoping for a sudden and permanent fix, and Lubin stresses the need to regard fibromyalgia as a chronic disorder, like diabetes or hypertension, lifelong ailments with symptoms that can be managed through consistent treatment.

"The first thing they need to understand is the adage, 'Chronic pain is chronic,'" Lubin said. "There are patients who will never be able to wrap their arms around the chronicity or durability of their pain and how much we understand it to be chronic. That makes for at times a very difficult practice."

Lubin, who trained at Yale and Harvard, uses various methods to combat the symptoms of fibromyalgia and similar maladies, including nerve blocks, nerve excision, steroid injections, radiofrequency ablation and various kinds of injections into trigger points, as well as pain medications ranging from anti-inflammatories to morphine.

He also sometimes prescribes antidepressants or refers patients for psychiatric counseling. The Food and Drug Administration has not approved any medications specifically for fibromyalgia, meaning any drugs are prescribed "off-label."

Dr. Roland Staud, a professor at the University of Florida's school of medicine, said several drugs are nearing submission to the FDA for the treatment of fibromyalgia. Staud is also involved in studies of cognitive behavioral therapy, which he considers an essential element in treating chronic pain. There is continuing scientific debate over the pain centers stimulated by fibromyalgia, and Staud focuses his research on the spinal cord as the source of pain transmission.

"When it is difficult on the physical level to reduce pain generation, then we need to also affect the central mechanism, which is, for example, negative mood, anxiety, fear, anger - all these things come into play in chronic syndromes like fibromyalgia," Staud said. "This acknowledges the mind-body connection that everybody has. It doesn't just marginalize this as purely a psychological syndrome."

Dr. Patrick Wood, an assistant professor of medicine at Louisiana State University, has also devoted his career to studying chronic pain disorders. In Wood's view, fibromyalgia results from the failure of patients' brains to make and use dopamine, a chemical involved in transmitting signals between cells.

Wood said experiments with drugs that mimic the effects of dopamine have shown promise, and he stressed the difference between this approach - targeting the source of pain - and the prevalent strategy of managing the symptoms.

"Our treatment of the symptoms has been sort of a shot in the dark because we don't really understand what it is we are treating," Wood wrote in the January issue of The Journal of Pain.

One Lakeland doctor takes an entirely different approach. Dr. David Reifsnyder, an infectious disease specialist, suggests many patients diagnosed with fibromyalgia and similar maladies actually have an undiagnosed viral or bacterial illness, such as chronic mononucleosis, chronic mycoplasma, Lyme disease or even cat scratch disease. He said in other cases he finds a simple cause of the symptoms - for example, a bad reaction to a medication.

"In my own personal experience, (in) about 95 percent of the people I see with either chronic fatigue syndrome or fibromyalgia, the cause is found, and the vast majority of those respond to treatment and recover completely," Reifsnyder said.

He said many of his patients are referred by other local doctors, who are happy to pass along patients with seemingly intractable ailments. Reifsnyder has long-term patients who now live as far away as California but still come to Florida to see him.

Reifsnyder, who operates a solo practice, devotes a full hour to a patient's first visit to take a thorough medical history, looking for clues to any undiagnosed chronic illnesses.

"Often patients come out of his office crying with relief," said Reifsnyder's wife, Nellda, who works in his office. "One patient said, 'This is the 44th doctor I've seen.' They're very angry. They say no one has listened to them."

Gary White can be reached at gary.white @theledger.com or 863-802-7518.