Talk:Fibromyalgia/Archive 1

Recent changes
There were some recent changes by 212.83.178.60 that I don't agree with. He changed "and is probably genetic" to "and is unlikely genetic". Why the change? I don't want to get in an edit war, but "probably" is correct.
 * a reference is needed for either statement.

He removed the line "but there is no strong correlation between any specific type of trigger and the subsequent initiation of fibromyalgia." Why? There isn't a strong correlation.

He also added "particularly if this involves injury to the neck" regarding triggering fibro. I don't know of any evidence of this. Is this just speculation?

Quadell 13:29, May 3, 2004 (UTC)


 * While I disagree with the rest of his changes, the last (regarding neck injury) is entirely possible. Most researchers currently agree that fibromyalgia is a neurological disorder, effectively heightening sensitivity to pain (as seen by increased levels of Substance P in the spinal cord, lowered levels of serotonin, and other abnormalities), which may or may not sometimes be triggered by neck injury. (Reference: ) 69.232.119.171 20:06, 1 May 2005 (UTC)
 * This was me. :) -- Niveousnet 05:14, 2 May 2005 (UTC)

Changes on 5/3/04
Although genes for fibromyalgia have not been located, statistically it has been shown to be genetic.

Much research has been conducted regarding the onset of fibromyalgia and a particular trigger, and no trigger is statistically favored. The phrase "particularly if this involves injury to the neck" is incorrect.

Guaifenesin is one of the safest drugs on the market. It has very few side effects, is approved for long term use, and is not harmful. Although the treatment is not widely prescribed at this time, it shows promise and should be included. Stating that it is harmful is incorrect as well.
 * I hadn't noticed that line. Googling "Guaifenesin harmful" didn't turn up anything related. Certainly it's controversial, but I don't think there's any evidence that it's harmful. Quadell 14:44, May 3, 2004 (UTC)

I will wait a couple days for discussion on this before changing it.

--Beth ohara 14:37, May 3, 2004 (UTC)

... I'm pretty sure that Dryland (2005) says it's not genetic, though that does conflict with earlier literature. It'd be nice to see a review of the genetic or not theories over the past decade.--Aunt Amanda 06:31, 24 October 2006 (UTC)

Sex Ratio
The current ratio is listed as 3-5:1 Female-to-Male, but according to the eMedicine article on FM: http://www.emedicine.com/med/topic790.htm the ratio is 9:1 Female-to-Male. I'm not sure if I should edit this since I don't know where the current listing came from.

The numbers will vary depending on the criteria (worldwide, just US) the age group (all, adults, older adults), and the diagnostic method (diagnosed with criteria x, diagnosed with criteria y, estimated with corrections for reporting bias, etc).

It would probably be best to list two or three figures, given the authorites for each (eg, "the ratio is calculated to be 9:1 by the US xxx Assn, but the International XYZ Assn estimates 3.8:1").

References are needed for a couple of paragraphs in the treatment section, they have been commented out in the meantime. redcountess 20:10, August 22, 2005 (UTC)

Spiritual Assertions
I've removed the following from the article:
 * Some people with Fibromyalgia use spirituality as a form of treatment. Praying, meditating, or connecting with a higher being diverts the attention of the patient.  They are no longer thinking about their pain but relying on the supernatural powers of the one whom they believe in.

While meditation is an important healing tool, I don't think it should be put forward as a form of treatment, especially the reliance of supernatural powers of higher beings. redcountess 20:32, Mar 22, 2005 (UTC)
 * In what sense are faith-based approaches to healing different from unproven and unproveable alternative medicine? I think it should be put back. JFW | T@lk  22:59, 22 Mar 2005 (UTC)
 * The information is, as written, NPOV and factual. NPOV requires we list all veiws: even those we disagree with. (Thanks for bringing this issue to talk, by the way, instead of just removing it without comment.) – Quadell (talk) (sleuth) 23:33, Mar 22, 2005 (UTC)
 * The only problem I have with that passage is that it could equally be written about any disease or ailment (or adverse circumstance of any kind, actually, including "being dumped by your girlfriend," "going broke," and "learning that your cousin has died"). As such, it says nothing whatsoever about Fibromyalgia, per se. --Ray Radlein 22:30, Mar 23, 2005 (UTC)
 * Hm. Interesting point. I guess the reason it's particularly relevant here is that there is no known, scientifically-proven treatment, and it's a painful condition. (My wife has it.) So people expect there to be a cure, or at least a treatment program, and so this is what some people do. Yeah, they pray and focus on spiritual things to deal with Strep Throat too, but that's not a significant part of treatment. Now having laid out that argument, I'm not totally sure I've convinced myself, and I'm open to other thoughts. – Quadell (talk) (sleuth) 23:49, Mar 23, 2005 (UTC)
 * I've commented it out (not deleted it) until we have a good reference showing why it's relevant to fibro in particular, not just to any ailment that mainstream medicine has trouble solving as yet. As is, the para reads to me like an ad - David Gerard 16:32, 25 Mar 2005 (UTC)

I talked with my wife about this (yes, our pillowtalk is laced with references to Wikipedia), and she said the paragraph might be relevant in articles on pain, chronic illness, or spirituality, but that it's not appropriate in this article. Maybe I'm biased, but I think she's right. – Quadell (talk) (sleuth) 17:28, Mar 25, 2005 (UTC)
 * Heh, yours too? :-) - David Gerard 12:06, 28 Mar 2005 (UTC)
 * I agree that this is not appropriate for inclusion here. Maybe it would be on an article on spirituality  but not here.  MollyBloom 19:07, 3 June 2006 (UTC)

copyright
This information is a c'n'p from http://www.fibromyalgia-associationuk.org/whatisfm.htm. The information is © 2002 Fibromyalgia Association UK, but for this page the site says "you are welcome to print [it] out for your use". Is this enough permission for Wikipedia? ²¹² 13:28 10 Jun 2003 (UTC)
 * I wouldn't say so. Can the page not be rewritten? Theresa knott 14:56 10 Jun 2003 (UTC)

Removal of some comments
If anybody want to work something out of what I just removed, it's here in the history. --Menchi 05:43, 21 Sep 2003 (UTC)

Chlamydia pneumoniae help & treatment (formerly "finally getting well")
I've had fibromyalgia for decades. I am finally getting well treating it as a stealth infection. http://www.cpnhelp.org/ is started and run by patients. It is noncommercial. I would like it included in the links. I am grateful I found the site, and want others to find it, too.
 * I think it is good to have links to various support information, but is this a commercial site? Not sure by looking at it...MollyBloom 19:06, 3 June 2006 (UTC)

The site is non-commercial, and says that clearly on the home page. It is privately owned and run (I am the founder of it), but there is no advertising or selling of products allowed, only discussion and information about treatment of Chlamydia pneumoniae in a variety of diseases including Fibromyalgia, Chronic fatigue, Multiple Sclerosis and others via a protocol researched at Vanderbilt University.

5/5/04 Changes
I kept the recent grammar changes, but removed the incorrect information that was discussed above. I welcome discussion on these points.

--Beth ohara 20:55, May 5, 2004 (UTC)

Stated evidence

 * There is stated evidence that chronic fatigue syndrome is the same disorder as fibromyalgia in individuals with high pain tolerance.

That's interesting, but what is the evidence, where is it stated, and by whom? -- 08:31, 18 Sep 2004 (UTC)

I am in the middle of a move and have all my references boxed up. As soon as I unpack them, I'll be glad to provide references for this.

Beth ohara 17:52, Sep 19, 2004 (UTC)

My docs explained it to me as a spectrum, with CFS on one end and FM on the other. Dryland (2005) theorizes that the two are very different and not related if I understand correctly (I read his book this morning, borrowed from a friend and don't have it in front of me) which is different from what I'd understood previously.--Aunt Amanda 06:33, 24 October 2006 (UTC)

Look in the book "What Your Doctor May Not Tell You About Fibromyalgia" by R. Paul St. Amand, Warner Wellness 2006. It states that Chronic Fatigue Syndrome is the same disease as Fibromyalgia, but the difference in manifestation is due to the difference in pain tolerance (as noted by the first comment above). I'm new at commenting so sorry if I'm not following protocol. I made an edit and took the word "unrelated" out of the paragraph that lists comorbid diseases. The reasoning is the same as chronic fatigue, and the reference is also the same. I added vulvodynia and interstitial cystitis to comorbid conditions and listed Dr. St.Amand's view that these are all subsets of FM. I'd like to add www.vulvarpainfoundation.org to the online links because they do a good job setting out the connections between FM, vulvar pain, interstitial cystitis, irritable bowel and other connective tissue diseases. Also FYI Dr. St. Amand told me personally that FM is not an autoimmune disease and that this has been disproven. Hsiaokuo62 02:48, 1 November 2006 (UTC) Hsiaokuo62 lwittke@npgcable.com

Current and forthcoming edits, concerns
I am relatively new to Wikipedia, so I apologize for stepping on anyone's toes if I have done so -- it is certainly not my intent.

I just tentatively reorganized/expanded the treatment section of this page, and I am considering expanding it further so as to be slightly more comprehensive -- i.e. perhaps a list of treatments? Would putting an external link or two regarding each treatment next to that treatment's mention be more appropriate than sticking it down at the bottom? (I'll check and see if there's any "footnote" formatting on Wiki.)

The theories/causes section... most researchers do now lean toward a neurological/central nervous system explanation for FMS, to my knowledge, yet it only gets passing mention in the causes section, not even an explanation. I have done a lot of research into this over the past few years -- if only I had collected my resources! Now I have to go find them all again. Regardless, I expect to be expanding on this somewhat in the next few days. (I have FMS myself, and I only have energy for so much ;))

Anyway, if I have done anything wrong, please inform. Thank you! -- Niveousnet 05:14, 2 May 2005 (UTC)


 * You are free to make these edits - if someone doesn't like them they will simply be reverted. Only on very controversional pages woult it be wise to request "permission" before introducing material or making changes.
 * Footnote formatting is not yet standardised, but you can use etc. (see here for an explanation). Generally, I find this better than inlined links, but this is entirely personal.
 * Are you sure researchers have abandoned the CNS/neurological explanation? This is not quite my impression... JFW | T@lk  21:16, 2 May 2005 (UTC)

Links at end
The number of links at the end is overwhelming, which makes it hard to keep out sites with commercial interests. There's a long section called "references", but since they don't tie to any specific assertions in the text, they should just be "external links", like the rest of them. For now, I'm just merging them into a single section, but I think they should be categorized and reduced in number. Does anybody have any opinions on which ones should stay and which should go? --Arcadian 23:18, 1 December 2005 (UTC)


 * The ones from important organisations and authoratitive health information outlets can stay. Personal webpages, blogs and other transient phenomena make poor links. JFW | T@lk  01:14, 2 December 2005 (UTC)

I've winnowed down the External Links list some, and got rid of the ones that seemed most commercial and the ones that were the most tangential. The six left aren't necessarily the best on the web, but I think they're the best of the ones that had been submitted. I also put in the "BEFORE inserting new links here you should first post it to the talk page otherwise your edit is likely to be reverted" comment at the top of the section. You guys might want to take a look to see how you feel about the current list. --Arcadian 03:40, 2 December 2005 (UTC)

A breakthrough not mentioned
I have had chronic fatigue (sorry, not FM) for years now. I am certainly no medical expert or microbiologist, and I'm new to wikipedia, so I don't feel it's my place yet to edit anything. I've done a LOT of reading online over the years, and I recently found a very interesting article (more so than the typical article on CFS/FM) that links chronic fatigue syndrome/fibromyalgia to sinusitis that is specifically caused by staphylococci.

http://www.masmith.inspired.net.au/aus_info/bioscreen/toxic.htm

Having lived with chronic fatigue for many years now myself, I would love to see this information mentioned (at least briefly) under "staphyloccus" and especially under "chronic fatigue syndrome" and "fibromyalgia".

68.35.13.128 05:10, 4 December 2005 (UTC) SH


 * It's not proven. JFW | T@lk  05:15, 4 December 2005 (UTC)


 * Unproven theories should still be listed, if they're noteworthy. – Quadell (talk) (bounties) 07:05, 12 December 2005 (UTC)


 * Absolutely, but this theory is not noteworthy compared to the myriad other theories about fibromyalgia. JFW | T@lk  10:32, 12 December 2005 (UTC)


 * None of the theories on FMS have been "proven". --Biochemza 23:10, 20 April 2006 (SAST)


 * Side note and little rant - This makes them all "hypotheses", rather than "theories", but there is no solid proof of anything. Which is taken as proof by skeptics for their "theories"

Additions from a fibro-skeptic
In regards to this addition, I think it's important that a skeptical view be represented. However, there are numerous dubious claims made that are not sourced. I'm rewording parts, moving them, and removing a few parts. If there are sources for statements such as "Most practitioners that actually treat patients who have been given the diagnosis of fibromyaligia feel that it is not an actual disease" and "Most patients report no relief with medicines other than narcotic analgesics", then let's discuss them here. – Quadell (talk) (bounties) 15:39, 14 January 2006 (UTC)

The 3-10% figure mentioned in the intro seemed remarkably high to me; on the first of the ext. links it says: "According to a paper published by the American College of Rheumatology (ACR), fibromyalgia affects 3 to 6 million - or as many as one in 50 - Americans." Well, 1 in 50 is 2%, and it seems like they are saying this is a relatively high estimate ("as many as"). The second ext. link mentions a 3-6% figure. Everyking 09:19, 6 February 2006 (UTC)

Well, INTERESTINGLY, someone REMOVED the latest functional resonance imaging studies that support evidence of augmented pain response that I posted.

www.nidcr.nih.gov/NR/rdonlyres/ 2F6D6B72-7144-4FD7-9BBF-CC467826585D/4948/ArticleNo50.pdf

Delisted GA
Hi. I have removed this article from the Good article listing due to the following:
 * No references. One of the GA criteria is that a reference section must be provided.  Inline citations are preferred but not required.  When this issue has been addressed, please feel free to re-nominate.  Thanks! Air.dance 04:06, 25 March 2006 (UTC)

Addition of resources/links
What are the criteria required of this article to add links? I must say, this is the most moderated Wikipedia page I've ever seen (but I don't edit that much, gasp shock, horror). Having FMS myself, I'v found it very useful to have other people to talk to, and there is a very useful podcast (the only one on the internet, at this time, I believe) dedicated to Fibromyalgia (and chronic fatigue). Knowledge is power, and the more people can learn, and the more people are exposed to differing views on the subject, the better choices they can make about their own treatment. This podcast has a linked Yahoo group  which discusses the podcasts, and shares medical literature (peer-reviewed articles from respected medical journals). Unlike other discussion groups, they also discuss the aspects that no FMS sufferer really wants to acknowledge - the theories of illnesss behaviour based on labelling, theories about how FMS is all just a bunch of hoohaa, etc. I think a group like that would be a useful link to add to this page.

Question
I see that differentials include lupus. I have been diagnosed with lupus and MS, and my rheumatologist suggested that fibromyaliga that I developed was secondary to those diseases. Is this possible? From what I have read, this is a theory. Shouldn't it be included?

By the way, I think this is a good article, and kudos to those who worked on it! MollyBloom 19:04, 3 June 2006 (UTC)


 * I believe it's pointed out here and on the lupus article that both conditions can be comorbid with other conditions. I'd be wary of repeating that by adding specific examples of what can develop alongside what.  Snowflake Sans Crainte 23:39, 3 June 2006 (UTC)

Fibromyalgia as severe TMS
I placed a NPOV-section in this section because the wording makes it appear as if TMS is a generally accepted syndrome, which, from what I can tell, it is not. I tried to think of some different wordings or additional information to add, but didn't come up with anything satisfactory, thus the NPOV marking. Davedrh 04:12, 14 June 2006 (UTC)


 * The diagnosis of TMS (tension myositis syndrome) has been used since 1984 by Dr. Sarno of the Howard A. Rusk Institute of Rehabilitation Medicine and his followers to designate a mindbody disorder that causes chronic back, neck, or limb pain that is frequently mistaken for structurally caused pain. Dr. Sarno says on p.62-63 of Healing Back Pain: The Mind-Body Connection (1991) "Typical of these reports is one published in the Scandinavian Journal of Rheumatology in 1986 (Vol 15, p.165) by N.Lund, A. Bengtsson and P. Thorborg titled 'Muscle Tissue Oxygen Pressure in Primary Fibromyalgia.'  Using an elegant new laboratory tool, they were able to measure muscle oxygen content with great accuracy and found that it was low in the painful muscles of patients with fibromyalgia."
 * "What this means for the etiology (cause) of TMS, as I have long maintained, is that fibromyalgia, also known as fibrosis and myofibrositis (and to some as myofasciitis and myofacial pain), is synonomous with TMS. I have treated a large number of patients who came with the diagnosis of fibromyalgia; their medical histories and physical examinations were consistent with severe TMS.  As proof that the diagnosis was correct, they recovered completely."
 * In his later book, The Mindbody Prescription: Healing the Body, Healing the Pain (1998) in which he expanded the TMS diagnosis to other TMS equivalents based on his long experience at the Rusk Institute, he says on pp 76-77, "I have maintained for years that fibromyalgia was a severe form of TMS. The similarity of my findings to the diagnostic criteria of the American College of Rheumatology reinforces that diagnostic conclusion."
 * "People with fibromyalgia commonly have psychological symptoms as well. They are often anxious and depressed, have sleep problems and suffer from lack of energy."
 * "Since fibromyalgia ia part of TMS, I have seen and sucessfully treated many patients who had been given that diagnosis before they came to me."
 * In Dr. Sarno's latest book, The Divided Mind: The Epidemic of Mindbody Disorders (2006), he says on pp.21-22, "Fibromyalgia is a medical term that has been around for a long time. For some reason it was adopted by the rheumatology community in the early 1980s and applied to patients suffering pain in many locations in the trunk, arms, and legs.  In fact, it is a severe form of TMS.  Significantly, fibromyalgia patients commonly suffer from other mindbody disorders as well, like headache and irritable bowel syndrome, as well as emotional symptoms including anxiety, depression, and sleep disorders.  When rheumatologists first became interested in people with these symptoms, they were not able to explain what caused the disorder, but they created diagnostic criteria to define it.  That became a kind of medical kiss of death.  The American College of Rheumatology decreed that the diagnosis could be made if the person under examination exhibited pain in eleven of a potential eighteen locations.  Since that time, hundreds, if not thousands, of papers have been published describing studies that try, still unsuccessfully, to explain the disorder.  Two of these published studies of people with fibromyalgia found that the oxygen levels in their muscles was reduced, confirming the hypothesis that fibromyalgia is a manifestation of TMS, which we've seen is caused by mild oxygen deprivation.  But the rheumatology community community did not accept the idea of mild oxygen deprivation as the cause of fibromyalgia, and the epidemic continued.  By the year 2000 the enormous increase in the number of people with this diagnosis prompted an article in The New Yorker magazine by Jerome Groopman, a professor of medicine at Harvard, in which he noted that there were six million Americans (mostly women) with this disorder of unknown cause and that it appeared to be analogous to the nineteenth-century epidemic of neurasthenia."
 * "The fibromyalgia story is another tragic example of the epidemic proclivity of psychosomatic disorders when they are misdiagnosed and, therefore, inevitably mismanaged."


 * I have removed the NPOV designation based on this discussion. The fact that Dr. Sarno and his associates have successfully cured supposedly incurable fibromyalgia by treating it as severe TMS should cause other doctors to give more attention to his diagnosis, and should give the millions of sufferers given the diagnosis of fibromyalgia real hope for a real cure.Ralphyde 00:09, 23 June 2006 (UTC)


 * Ralphyde, first off, where did you find this "discussion"? It certainly does not appear to be of journalistic quality. It also incredibly biased (with such wording as "for some reason, fibromyalgia is accepted as a disorder"). It also has a lot of basic facts wrong. I don't understand how in one article, this person states that FM is not real, and follows it up by claiming that fibro is part of TMS -- which one is it?


 * Additionally, keep in mind that one doctor (and his "team) has found these conclusions. They are not generally accepted in the medical community -- at least not yet. Furthermore, Dr. Sarno is not claiming he has found a cure -- he has found a connection between two diseases (which he erroneously refers to as psychosomatic disorders). He is claming he has found treatment. Many patients have already found treatment -- at times this treatment can cause a temporary remission. However, there is no cure for fibromyalgia.--Meg 15:23, 27 June 2006 (UTC)


 * Meg, First off, I told you exactly where I got this "discussion," the books and page numbers are given above. Secondly, that quote you made, "for some reason..." does not seem to exist. The closest thing I can find is the quote above from Dr. Sarno's recent book, The Divided Mind: The Epidemic of Mindbody Disorders (2006), "For some reason it (the term, Fibromyalgia) was adopted by the rheumatology community in the early 1980s and applied to patients suffering pain in many locations in the trunk, arms, and legs.  In fact, it is a severe form of TMS."  Thirdly, what basic facts do you think Dr. Sarno has wrong?  And he doesn't say that FMS doesn't exist, but does say that the cases that have come to him with a diagnosis of FMS from other doctors have evidently been misdiagnosed, as they are actually severe TMS, tension myositis syndrome, a mindbody disorder for which he does have a "cure."


 * So there are millions of "fibromyalgia" patients out there in the most severe chronic pain that have been told by their doctors that there is "no cure," for them, when in fact, Dr. Sarno, and other doctors, have indeed been curing such patients by correctly diagnosing them as severe cases of TMS. This is indeed tragic for those suffering millions who were told there is no cure.


 * I would like to point out that Dr. Sarno is 83 years old and still seeing and curing patients at the Howard A. Rusk Institute of Rehabilitation Medicine at NYU Medical Center, and is a Professor of Clinical Rehabilitation Medicine at the NYU School of Medicine. He has been curing patients with severe chronic pain for three decades.  His beliefs are based on more than thirty years of frontline clinical experience, and he has written four books about his successful breakthroughs.  I suggest that you read Dr. Sarno's latest book, The Divided Mind: The Epidemic of Mindbody Disorders (2006), before you are so quick to say that his work is "erroneous."


 * In this book are chapters by six other doctors who accept his theories and approach, including a chapter by Andrea Leonard-Segal MD, a board-certified internist and rheumatologist, and assistant professor of Medicine at George Washington University Medical School and a physician at the Center for Integrative Medicine at GWU Medical Center. She says on p. 265, "As with other TMS patients, those with fibromyalgia can be helped if they are open to considering and then accepting that there is a psychological cause for their pain.  If they are unable to be open in this way, I have not been able to help them."  TMS requires acceptance of the diagnosis for the treatment to bring about a cure, but when there is acceptance and understanding, and the requisite changes in attitude, then significant improvement and even complete cure can rapidly follow.


 * Dr. Leonard-Segal concludes on p. 269-270 that, "The beauty of the TMS diagnosis is that it is a hopeful one that can result in a true cure. The treatment leads to resumption of full physical activity, the emergence of a more emotionally healthy life, and an education in self-awareness.  The patient who has recovered from TMS grows into a happier, more comfortable, more peaceful person who sees new paths toward greater personal fulfillment."


 * I would also suggest that you read Freedom from Fibromyalgia: The 5-Week Program Proven to Conquer Pain (2001) by Dr. Nancy Selfridge and Franklynn Peterson, both of whom cured their own fibromyalgia by using Dr. Sarno's treatment plan for TMS. People suffering with "fibromyalgia" need to know that there is hope for them, and that some doctors have found a cure for them that works!Ralphyde 19:29, 27 June 2006 (UTC)


 * Sorry Ralphyde, your citing a book that expresses an opinion. An opinion does not matter in wikipedia. It may be your opinion too, that does not matter either. It also does not matter how many patients he claims to have cured, nor does it matter how old he is, nor does it matter how many other people helped write the book.
 * Why does it not matter? Because if it did, I could write a sentence behind your sentence: "Other doctors think that's a prime example of bullshit and psychobabble" and then cite a suitable book, there are engough of them, by all means.
 * Or I could use my academic titles, write a book about stating that fibromyalgia can be cured by Snake oil, put it in and cite it. Or writing a book together with some colleagues stating that you are Eva Braun and then cite it. (I am just kidding, I don't mean to offend you, ok, I am just trying to illustrate my point)
 * The reason why I am not doing it, is that it would be below Wikipedia Standards for a medical aritcle.
 * I am sorry, from what you write I would guess that you would actually want to help people, but if you want to prove your point in a medical article, you have to come up with studies or reviews. A book about X by Dr. Y ist not enough.


 * You set yourself up as a Wikipedia expert, upholding "Wikipedia standards," yet you don't have the courtesy to use your name or even sign your posts, and then you remove cited and relevant text claiming it is just "opinion." You sound like a POV-warrior who used to be active, who was subsequently banned for marking everything he didn't believe in as "not scientific."


 * In this case you are accusing respected physicians with decades of successful clinical experience of being "just opinion." For example, Dr. Sarno is a Professor of Clinical Rehabilitation Medicine at the New York University Medical School and attending physician at the Rusk Institute of Rehabilitation Medicine at the New York University Medical Center where he has been seeing and curing thousands of real patients in serious chronic pain day in and day out for over thirty years.  He has found through experience what works, with a 90% success rate, and has written four books on his theories and methods, and has a worldwide reputation for healing chronic pain.


 * Dr. Andrea Leonard-Segal, whose reference you also arbitrarily removed, is a board-certified Internist and Rheumatologist, and a Professor of Medicine at George Washington University Medical School and a physician at the Center for Intergrative Medicine at GWU Medical Center. See the quotations from her chapter in, The Divided Mind: The Epidemic of Mindbody Disorders (2006)above.  Her article is entitled "A Rheumatologist's Experience with Psychosomatic Disorders," and is based on her solid clinical experience.  For you to delete such references with a know nothing skeptical attitude is not only arrogant, but also deprives suffering millions of finding a proven path out of their very real suffering to a pain free life.


 * Unfortunately, since Descartes, mainstream medicine has cut itself off from mindbody medicine and only physical causes are sought for physical symptoms, and if the true cause is emotional or psychological, it is overlooked and treatment is not successful. Fortunately, this is changing.  Our bodies aren't just machines.


 * As Dr. Marc D. Sopher, puts it in his book, To Be or Not to Be... Pain-Free(2003), on pages 6-7, "TMS is a strategy of the brain's to keep unpleasant thoughts and emotions from rising from the unconscious into the conscious mind. The brain, through established physiologic pathways, creates pain as a distraction.  By focusing our attention on physical symptoms, we keep these painful thoughts and emotions repressed.  This is a very effective strategy as there is an absolute epidemic of mindbody disorders in our society.


 * "Eliminating the pain is startlingly simple. We can banish the pain and thwart the brain's strategy by simply understanding and accepting that the pain has a psychological causation, that it is not physically based.


 * "While much of the pain we experience has a psychological basis, it is essential to first be evaluated by your physician to determine that there is not a significant disease process. Unfortunately, if your physician does not consider TMS in the process of generating a differential diagnosis of your symptoms, it is possible that he or she will give an incorrect diagnosis.  This occurs all too frequently as a physical cause is mistakenly offered.  This results in a treatment plan that it often unsuccessful.  As an example, many people with back pain are told that their symptoms are due to a herniated disc or disc degeneration, when in fact these findings are often incidental and normal.  This helps to explain why physical therapy, medications, and surgery are often unsuccessful." pp 5-7


 * Dr. Leonard-Segal also discusses the difficulty of creating studies with mindbody disorders such as TMS: She says, "It is difficult because psychological treatments do not easily lend themselves to the ideal clinical trial methodology. How can we conduct studies to see if psychological approaches can cure this condition?  Patients with TMS must be psychologically open to the diagnosis to improve.  They must be ready to renounce the idea that their cure is to be found in structural or chemical means.  Thus, it would be exceedingly difficult, if not impossible, to conduct a study in which patients with the same condition are randomly assigned to different treatments, one of which is the TMS treatment.  Because getting better depends on accepting the TMS diagnosis, most patients assigned to TMS treatment would not improve because they would not be able to accept the diagnosis." p.259


 * And not accepting the diagnosis would be the equivalent of not taking one's prescribed medicine.


 * If you are a Fibromyalgia patient and wish to get rid of your pain, I strongly suggest you look into the above mentioned books, and let go of the conventional and toxic idea that there is "no cure."


 * Another book that builds on the mindbody approach, by a doctor who cured herself from fibromyalgia using Dr. Sarno's approach, is: Freedom from Fibromyalgia: The 5-Week Program Proven to Conquer Pain (2001) by Dr. Nancy Selfridge and Franklynn Peterson.  There is real hope out there for you.  If you don't believe it, just read some of the customer reviews of these books on Amazon.com.  Mindbody medicine is real, and more and more doctors and patients are finding through their own experience that it works. Ralphyde 23:02, 26 February 2007 (UTC)


 * For your information, I am not a FM Patient. I am sorry Ralphyde, I guess you really are trying to help people out. And you have an opinion about how that can be achieved. But that is not relevant for Wikipedia - it's just your opininon and our POV. And you can't keep it in the article unless you have scientific evidence living up to Wikipedia's Standards to back it up with. Again a book written by whomever will not do. And no matter how much excerpts you post and how often you reassure that this is definitely right - it won't do the trick. Come up with evidence (admitted, that IS difficult) or stay down.


 * Who are you? and why don't you sign your posts? And where do you get off arbitrarily deleting cited text in an area you don't seem to know much about? I would call that vandalism, not discussion.  You don't think decades of successful clinical experience constitute scientific evidence, and so you delete it. Ralphyde 17:05, 28 February 2007 (UTC)

I have removed the mention of this information from the introdiction to the fibromyalgia article, as it does not belong there, it is fine to mention it under alternate theories, or whatever, but listing it in the very opening paragraph is irresponcible, and misleading, as there have been numerous claims made that a cure has been found and as someone who has to live with this condition, I find it deplorable to find the newest "cure" mentioned in the opening paragraph. I have no problem looking at the information, but unless the guy gets some more PROOF other than his own opinion, I will delete it every time it shows up in the opening paragraph. Again I stress I have no problem with a link and mention of his theories elsewhere in the article. But if someone whose life has been destroyed by this disease comes looking at the article and finds a mention of a cure, that has little more credibility than snake oil, well its irresponcible and cruel.Correctwiki 07:23, 12 May 2007 (UTC)
 * You really should sign your posts. And if you truly want a cure for your condition, you should read the above mentioned books, but first click on the above links and go to the Amazon.com customer reviews of those books.  There you'll find the testimonies of many people who have cured themselves of fibromyalgia by using the mindbody techniques therein, especially, the book by Dr. Nancy Selfridge (click this link), who cured herself of fibromyalgia using Dr. Sarno's methods.  You'll find a few skeptics, but many more who cured themselves.  And Dr. Andrea Leonard-Segal, a board certified Rheumatologist, and a Professor of Medicine, adopted Dr. Sarno's mindbody techniques after he cured her of her own severe chronic back pain.  And Dr. Sarno, now 84 and still curing people with fibromyalgia, has been doing it at the [Rusk Institute] for over 30 years. You should really give yourself that chance, rather than believing the toxic statement that "there is no cure." Don't you want to get well? Ralphyde 06:25, 12 May 2007 (UTC)

Have you personally been cured by this book, or are you the doctor who wrote it? You are hyping the book as a cure then list it as the cure, or is it that it is a cure? for some? like i stated earlier i have no problems with it being mentioned as a possible cause and cure, but if you list it as a cure you have to list ALL other claimants to have provided "cures" as well otherwise it is dishonest, or you apparently have an agenda for pushing it, be it financial or otherwise. It belongs in alternate theories not in the opening paragraph as an advertisement. Correctwiki 07:23, 12 May 2007 (UTC)

I have moved ALL of the references from the main article, and placed them under this sub heading, I deleted NOTHING, Just re arranged it to give this theory its proper place, as a theory, along with the other theories about this disorder. Again I stress I have no problem with including this information, as it may help SOME, but it is not nessesarily a cure all, and should not be disingenuously portrayed as so. I have investigated this route in the past, and it has not personally helped me in the slightest, however, I realize it may help others, but it belongs here, as an alternate, not given preferential treatment because you in particular prescribe to it. I have noticed that several others have attempted to make this point with you in the past, yet you continue to treat the issue with some apparent agenda. I have only moved the references, to one subheading, which is clearly listed in the table of contents, Hopefully this will resolve the issue, as I have no desire to continually edit the page. But I will not allow you to monopolize the page, and give it some sort of slant, no matter what your reasons are, be they financial gain, personal favoritism toward the proponent of this theory, your own original research, or even misplaced altruism. Correctwiki 01:50, 13 May 2007 (UTC)


 * In answer to your questions, I have nothing to do with any of the books listed above other than having read them. I have been a serious student of chronic back pain and tension myositis syndrome since 2003 when a close family member had become nearly disabled by serious chronic back pain, which the conventional medical establishment was unable to relieve over a period of three years before discovering Dr. Sarno's methods. I have read over a dozen books on back pain and TMS since then, as well as many articles, as well as communicating with various sufferers of chronic pain and fibromyalgia.  Dr. Sarno, and the growing number of doctors adopting his methods, have shown the greatest ability to abolish such pain, and anyone suffering such pain owes it to themselves to investigate his approach, if they truly want to get better.


 * Another good friend, who had been diagnosed with fibromyalgia and had tried many different treatment methods to no avail, finally cured herself only after dealing psychologically with her severe repressed childhood parental abuse, she said, which fits in well with Dr. Sarno's theory that repressed anger and other unpleasant emotions that one doesn't wish to face are the true cause of the very real chronic pain, created as a distraction through the autonomic nervous system to aid the repression of such unpleasant emotions. The biggest problem with his method is that it won't work unless the patient is able to accept the idea that her pain might have a psychological rather than a physical root.  Accepting this, however, and changing one's attitude toward the pain, defeats the syndrome, and the pain recedes, as it no longer distracts one from dealing with the underlying emotional issues.


 * In the meantime, two other good friends of mine have cured their own longtime chronic back pain (17 years in one case), just by reading one of Dr. Sarno's books. Chronic back pain, along with fibromyalgia and some other ailments have reached epidemic proportions, increasing at fourteen times the rate of population growth. Here's a new interview (April 10, 2007) with Dr. Sarno (He's 84 now and still seeing and curing patients, due to his worldwide reputation for success) that you might wish to listen to.  Ralphyde 19:58, 13 May 2007 (UTC)

Thats fine, and I have already explored these avenues myself, and been unsuccessful, and yet again I will continue to revert the page if you continue to do so, I even went to far as to keep all your previous information in my last revision, only just consolidating it under the TMS subheading, If you wish to continue this I can and will do so as well. But yes I am offended, you a person who has never even had the disease continue to attempt to monopolize the page and proport TMS as the "only" and prefered treatment. I repeat again all I have done is rearranged the info, and placed it inder its own subheading where it belongs.Correctwiki 04:11, 14 May 2007 (UTC) Why not read the page instead of reverting it without looking at it.


 * Dear Correctwiki, I am sorry you have suffered with this syndrome for so long. Have you read Dr. Nancy Selfridge's book, Freedom from Fibromyalgia: The 5-Week Program Proven to Conquer Pain?  Did you listen to the interview with Dr. Sarno?  I have not attempted "to monopolize the page and proport TMS as the 'only' and preferred treatment," as you accuse me of.  It's just that the cited sentence you keep removing is totally true.  It says simply, "Because the nature of fibromyalgia is not well understood, some physicians believe that it may be psychosomatic or psychogenic. Although there is no universally accepted cure, some doctors have claimed to have successfully treated fibromyalgia when a psychological cause is accepted."  That's absolutely true on its face, and is cited.  It replaced the previous toxic statement "The nature of fibromyalgia is not well understood; some physicians believe that it may be psychosomatic or malingering. There are few, if any, treatments available. Although there is no cure, the disease itself is neither life-threatening nor progressive, though the degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission."  I don't make any claim that this is the "only and preferred treatment."  It's just that it's only the only cure that I know of, and it isn't even mentioned in the introduction, but only in the section on TMS, which I didn't write.  But your last edit totally messed up that section. Ralphyde 06:55, 14 May 2007 (UTC)


 * Correctwiki, if you want to purge ralphydes psychobabble from the article you can nail him with wikipedia's standards about medical article. A book doesn't live up to them. No matter how loud Ralphyde screams that Dr. Sarno is the best doctor and the friend of every patient. Go to pubmed, get some reviews about fibromyalgia research and shut him up. It's less dificult than it looks, because ralphyde is not following wikipedia's rules, so you can easily turn that against him. If he doesn't want to back down, because Dr. Sarno is a doctor and gave an interview, get an administrator to help you. Removing or diminishing the POV from a book in a medical article is rather easy. —The preceding unsigned comment was added by 192.68.211.173 (talk) 10:40, 14 May 2007 (UTC).


 * For instance, here is a link to a study from pubmed describing subgroups of fibromyalgia: :::http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17393187&query_hl=3&itool=pubmed_DocSum
 * One quote from the abstract: "Bland inflammatory processes must be considered as the cause in the first group, while depression is the underlying reason for the development of pain in the second group." So there you go. Ralphyde is unduely generalising - show him his place with this study and others. They all weigh more in wikipedia than the books he bought. —The preceding unsigned comment was added by 192.68.211.173 (talk) 10:52, 14 May 2007 (UTC).


 * Oh, look who's back. The guy from the German drug manufacturer, who never signs his posts, and would rather sell you drugs for your pain symptoms rather than have you get well by finding the cure. Oh well.  Here we go again. Ralphyde 16:32, 14 May 2007 (UTC)

Considering That I was being nice, and just re arranged your info myself, under the subheading, after asking you to do so. I am quite tempted to look into admin assistance. I am attempting to be nice, so if you want this info included, move it under the subheading, as there are many other doctors who make similar claims as dr sarno. As it stands you place TMS under the main heading convienently giving it preferential status to other treatments. I have not removed the sentence, just moved it to the tms subheading. Just because "some" believe it is true does not make it more or less valid, than other beliefs, therefore, as a concession, I have attempted to place all the info under the tms subheading. I cited 2 references that stated fibromyalgia, is debated to be progressive or not, and as mine has been, I do have contention with the statement it is not, especially when I am not alone. If you don't like my edit of the tms section, then by all means clean it up, but I will continue to remove it from the main article, and I may persue the above mentioned suggestion if you continue to place it there, and just have it totally removed ftom this article entirely. I find it telling that you have not tried to pull this stunt with clinical depression, or the most touted illness by the doctor himself back pain, oh lets not forget carpal tunnel syndrome. I suggest you leave it be, or you be genuine and cite at least those three articles with the same theory. Correctwiki 18:32, 14 May 2007 (UTC)


 * Correctwiki, did you even look at the entry you posted under 'Fibro as severe TMS?' It was totally broken and unreadable with a line extending well past the edge of the page with dashes around it.  Plus the information there was changed from the original.  If you want to modify someone elses work, you need to get the facts and format right.  As far as the intro goes, you can add your own statements and citations, just quit deleting other cited statements which are clearly true and cited.  Did you read my statement above about what it was changed from; a clearly false and toxic statement.  We both (I think) want people to be able to find that there are cures to Fibromyalgia, don't we? Ralphyde 19:09, 14 May 2007 (UTC)


 * I have restored your cited text in the intro. And you mentioned above that you had "already explored these avenues myself, and been unsuccessful."  I'd be very curious as to which of Dr. Sarno's books you had read, or whether you read Dr. Nancy Selfridge's book.  Many people have cured themselves using these mindbody techniques, but the key to healing is acceptance, and many can't accept that the cause could be emotional or psychological, and so they don't heal.  I am also trying to be nice, which is why I restored your cited text after you had removed mine.  Ralphyde 23:27, 14 May 2007 (UTC)

Major discrepancies with this article!!
Whoever has contributed to this article first off must not have fibro, and second of all, has not consulted a truly knowledgeable source.

When I was diagnosed, I instantly snatched up one of the best fibro books around: Fibromyalgia: Up Close and Personal, by Mark J. Pellegrino, MD []. The author is a physiologist who not only treats FM patients, he also has the disease (yes, disease) himself. He is widely considered one of the leading researchers of FM in the country, and his work has so far changed many physicians' opinion on the matter.

In this book, Dr. Mark asserts that fibromyalgia is not a syndrome (which typically defines something more psychological in nature), it is a disease of the nervous system -- not an exact quote from the book, but I can provide one if you like. It is a disease that screws with your pain receptors, which tenses you up, which leads to the many other symptoms of the disease.

It is definitely NOT a psychosomatic disorder as is listed in one of the first few sections! You do not see a psychiatrist for treatment. You see a rheumatologist or physiologist -- medical "pain" doctors.

That is the first thing that must be changed.

The second thing is this. It is true that some medical professionals do not acknowledge FM as a true medical disease. However, this sentiment is not expressed fairly in this article. Instead of stating "some doctors accuse their patients of fabricating their illness", why not say "because of its internal nature, and because no diagnostic tests have yet been developed (other than testing pressure points), some doctors do not yet accept FM as a medical condition"?

The majority consensus in the medical world is that FM is a real disease, but it is not yet understood. Therefore, many doctors are intimidated by it, and refuse to give treatment for it. Others fear their patient may become disabled, and then they'll have to assist the patient with the disability claims.

It is important to mention to you all that Alzheimer's was also initally not wholly accepted by the medical community, but became so after some time. As is the case for depression, dementia, Chronic Fatigue Syndrome...

For these two reasons, and for other reasons I don't have time to write about, it appears to me that this article was written with a strong anti-FM bias. It is also not factual in all places. Major rework needed. Consult and site medical (not internet) sources if you must post a "skeptical", generally rejected, opinion..


 * A syndrome is any collection of symptoms that occur together. It does not mean that they are psychosomatic - no one would suggest that acute coronary syndromes (ie heart attacks and unstable angina) are psychosomatic for example.  Maria
 * --Meg 14:55, 27 June 2006 (UTC)


 * One problem is that there is no evidence(at least objective) that fibromyalgia is any more than a "syndrome"? that occurs primarily in older women who are relatively physically inactive and do notstretch their muscles.Any physiologist or anyone who exercises knows that stretching is important to avoid injuries caused by shortened muscles. If one does not know that, then fibromyalgia may occur--shortened muscles that are tender, but unassociated with any laboratory, Xray or other findings. While physical therapy will alleviate the chronic problem--if the subject will exercise AND stretch, rather that feeling sorry for their misery(which is real)and gathering sympathy from caregivers. It may induce some depression, and the disability people do recognize it as a form of disability. However it is "self induced", lifestyle malady and can be alleviated by changes in lifestyle. Any one with a relative or friend with fibromyalgia should be able to recognize this--but instituting a change is difficult for the subject, so some in the medical field don't encourage the subject, but either write an Rx or don't deal with them. The only field of medicine that deals with these people effectively is the Mind-Body field, championed by a Dr. Benson? in Boston. Find him or his "students" by Googleing "Mind-Body". No Agenda, other than to educate. Fred MD


 * I was an athletic 25 year old man when I had my first symptoms (now 26). I was working at a physically strenuous job, and so the notions about lazy old women do not apply to me. I also do not suffer from depression, despite my relatively pronounced disability: I can no longer work or take care of myself, and when I can walk, I must use a cane. Even with my disability, I have excellent genes - I'm still very lean and muscular, and I look like I must workout in the gym every day. Clearly there is no problem with my physical activity level, and I'm otherwise extremely healthy and strong. However, most of the people with fibromyalgia may fit the "lazy old woman" stereotype, but that may be an upside down evaluation. What if "laziness" is caused by the condition? What if the condition becomes more pronounced with age? What if the disease mostly affects women? All of those things are true, and as such it's incorrect to make a causal judgement based on the fact that most sufferers are lazy old women. Rather, that's more likely a symptom of the disease, not the cause. I've become profoundly "lazy" since I've been struck by this. I have frequently been bedridden and literally unable to feed myself. Before this, I was a competitive athlete. There's no gray area from my point of view, this disease is real and horribly debilitating! I also must point out to you, Fred MD, that you are behind in your study of the current research on this topic. There are plenty of physiological indicators for this disease, with more being uncovered as research progresses - it's not just a nebulous catch-all diagnosis with no proven scientifically testable symptoms. Qwasty 00:13, 18 July 2006 (UTC)

After reading some of these 'medical opinions' it makes me wonder about MDs whether they do their job for the cushie hours and excellent pay or because they give a stuff about people. I my experience (as a Fibro sufferer) and of people I know who suffer from Fibro, it has struck young, active women and dibilitated them, and turned their life upside down. I am a very positive person, and am very proactive. I have never dwelled on this disease/ syndrome (I don't really care what you pigeon-hole it as) but have actively sought ways to get well. I do pilates twice a week to help stretch out spasming muscles (my pilates instructor also has Fibro by the way - I'd like you to tell her that she's lazy!), I always did eat healthily anyway, and take time out to relax when possible. My particular problems lie in sleeping. I have suffered from insomnia and lack of 'quality' sleep for also 15 years since my teens, I find that Amitryline has helped significantly, although I have to undertake certain destressing activities before bedtime also. I have never sought out a sympathy vote, but have certainly questioned my sanity following people attitudes to me (including seeing what one doctor wrote in my notes before I was diagnosed- appalling). You try not sleeping properly for 15 years and see how much ooomph you have in the morning! I can only describe it as the tiredness you feel when you have a new born baby waking you up all through the night, but everynight. And waking up feeling like you've slept on a hard floor. It is disheartening that MDs feel it appropriate to challenge a person as to their feelings and perceptions with this condition. All I would say is pray you never have to suffer from such a condition which touches everything in your life, and makes you struggle at the age of 28 to pick up your toddler when he's fallen over. And all this despite leading a healthy and active lifestyle, trying to do all the right things. It is these poor attitudes and negativity which helps it all the harder to cope with the condition.

Guaifenesin Protocol
I'm really uncomfortable with the line "One of the more promising approaches..." Umm, who says this is "promising?" And who are the "several doctors" who are now using this protocol. Don't get me wrong, I'm not saying it's untrue, but I won't be comfortable with it until it's sourced. Actually, a lot of this article is unsourced. "Studies have found gentle exercise, such as warm-water pool therapy, improves fitness and sleep..." What studies??? It's very worrisome to have so many "treatments" with no sources. DejahThoris 09:16, 1 July 2006 (UTC)


 * I have to agree with DejahThoris here. Unless these "treatments" and statements are sourced they should be removed.  We're supposed to be creating a entry in an encyclopaedia, not a resource of "handy hints" or a soapbox for any old tom, dick or harry to claim they can treat/cure this illness. Snowflake Sans Crainte 22:26, 3 July 2006 (UTC)

"No evidence" statements
Phrases claiming that there is no scientific or laboratory evidence for the factual existence of fibomyalgia are outdated and need to be stricken from this article. This article in its current form contradicts itself by mentioning sleep disorders, substance-p disorders, and other evidence while also saying there is no evidence. Qwasty 08:11, 3 July 2006 (UTC)

Merge?
GregorB has suggested merging Fibromyalgia_Syndrome with this article. I agree. Actually, the "Fibromyalgia Syndrome" article looks like it was lifted from the National Fibromyalgia Association, which I think is a copyright violation. DejahThoris 02:57, 7 July 2006 (UTC)


 * I'd agree with merging but any information that's been lifted wholesale from elsewhere (in both articles, should that be the case) should be removed or, if it's not already covered in this article, rewritten entirely to avoid copyright. Snowflake Sans Crainte 08:50, 7 July 2006 (UTC)


 * it appears this has been done. —Preceding unsigned comment added by Iggynelix (talk • contribs)

NPOV
This article does not conform at all to Wikipedia standards concerning NPOV. I cannot glean any information from this article regarding what, from my observations, is the generally accepted opinion of the medical community: that fibromyalgia is not a disease in and of itself, but is merely caused by depression and various lifestyle patterns (or so is my understanding). This article dismisses out of hand any skepticsm, or reduces it to a tiny collection of unsourced generalizations, which are not truly reflective of the debate over FM. Remember: it is not Wikipedia's job to be ahead of the curve. We report on what is the currently accepted concensus first, and leave secondary opinions for later. While some FM sufferers, and editors of this article, may not see physicians, JAMA, The Lancet...etc as reliable or unbiased sources, they are accepted as reliable and definitive by most others. This article treats FM as a fact that has yet to gain widespread expert endorsement or notice, instead of a theory that has yet to be proven or accepted by the majority of the medical community. Even if FM were 110% true in my eyes, I would still have qualms with stating it as fact until a few reliable, emperical, and widespread studies were published in reputable journals. No such thing is sourced here. We need editors from both sides of the debate here, as of now there seems to only be 'believers' (save perhaps Meg) posting here and editing, and that won't lead to an NPOV article.

Also, for those of you who are about to pull out the "evolution is a theory not a fact, yet you still accept it lol!" argument on me: evolution is not concretely proveable, but has been observed for over a century, and is accepted by almost every respectable scientist in the community- this is not the case with FM.

I appoligize in advance for ticking people off, but it's time this article was brought up to Wikipedia standards. --Ringmaster j 19:05, 31 July 2006 (UTC)


 * All recent serious medical documentation (See Harrison, UpToDate) have an accurate description of the "sindrome". If you read carefully you would notice that it is not caused by depression, rather it may cause depression. I'm suffering from it for 10 years. I can assure you it is supra-realistic real, I do not have abnormal "lifestyle patterns", nor was I depressed before or after the onset of the ilness. If you do not know about it you better refrain yourself from comments. Also, the ilness do has a history, long time it has been believed to be  degenerative reumathic disease and you find it  under name "fibrositis". -- M.

There is a section on Skepticism as required by the NPOV policy. – Quadell (talk) (bounties) 15:08, 24 August 2006 (UTC)

Wrong
Fibromyalgia is made up and wrong. It is purely a form of depression but people dont like to be told they are depressed. Any effects of "treatment" are purely a result of the placebo effect
 * Got any evidence for that? Any at all?  No?  Thought not.  Back under your bridge with ye.  Snowflake Sans Crainte 08:29, 24 August 2006 (UTC)
 * So untrue!!! The idea that people with fibromyalgia are just depressed (or even that we all have depression) is a stereotype that does not hold water. We have no more depression than others with similar chronic illnesses.  In my own case, I have fibromyalgia but have had several psychologists tell me and my doctors that I am definitely NOT depressed.  However, my pain and other symptoms are unfortunately very real. AliaGemma 00:14, 6 September 2006 (UTC)
 * In my experience and in numerous reports from friends and colleagues, GPs use the old 'you've got depression', as they are too bone-idle and lazy to look into symptoms and relations between existing ailments. It's a way to get you out of the door, you're depressed so take some of these and you'll be right as rain in 2 weeks.  It is scandalous.  I actually suffered from depression when I was in my teens (triggered by an event), I worked very hard with therapists and helathy mind healthy body etc. and recovered.  Several years later I began developing physical symptoms which led to an eventual diagnosis of Fibro.  I accept that this may have been triggered by the depression in a cause effect relationship, so I also understand that it is sometimes umbrella'd with depression for this reason.  But I challenge anyone which says it is a psychological 'syndrome' and doesn't really exist.  Work a day in a suffers shoes!

It's the old 'when a tree falls in the forest' argument.
 * a freind of mine recently died of what her physician indicated were complications originating from years of battling FS. Wikipedia is a place for open exchange of ideas; so if you choose to express your skepticism, please do so. However, it is reprehesible to summarily dismiss, without evidence, research or factual basis to support your assertions, the significant numbers of sufferers who reach out to the global medical community for answers . (see also Civility)Iggynelix 20:50, 13 March 2007 (UTC)

Fibromyalgia and Long Distance Bike Touring
I've removed the paragraph about Paula Werme's web page on | Fibromyalgia and Long Distance Bike Touring because while it's interesting, I don't believe it should have a paragraph to itself in the Skepticism section of the article. I believe this would be more appropriate as an External Link. Snowflake Sans Crainte 11:45, 28 August 2006 (UTC)

"Consumption of Alcohol"
I've marked the recent addition of "consuption of alcohol" temporarily increasing symptoms of fibromyalgia because I've noticed that it does the exact opposite in people I've spoken to (my theory being it doesn't change anything except the brain's awareness of the symptoms but that's another point entirely). Is there any actual evidence either way regarding the effects of alcohol on sufferers? --Snowflake Sans Crainte 16:38, 7 September 2006 (UTC)


 * Good question. The National Fibromyalgia Research Association simply states "A common thread in many cases of fibromyalgia seems to be a tendency to feel better when refined sugar, caffeine, alcohol, fried foods, red meat, and highly processed foods, are kept to a sound personal minimum in the diet," but it doesn't offer any evidence. The Bastyr Center for Natural Health claims that "the use of alcohol can cause 'leaky gut' syndrome which has been demonstrated by clinical studies to be a major factor in conditions such as fibromyalgia", but I'm not sure what they're calling 'leaky gut' syndrome, or how strong the connection is. And a somewhat scholarly article here says "Caffeine, alcohol, and sugar should be eliminated", but although the article has 18 footnotes, that part isn't footnoted. Several other prominant sites recommend cutting out alcohol, without saying why.
 * There are a couple of reasons I can think of, though. First, sleep disturbance exacerbates fibro symptoms (some theories say it causes fibromyalgia), and alcohol interferes with deep sleep. Anything that helps you get healthy sleep has to be good. Second, alcohol is involved in a huge percentage of all accidents, and physical trauma is often a trigger for fibro getting markedly worse. Third, many fibro patients are on pain medication, and alcohol can be very harmful when combined with pain medication. And lastly, alcohol is of course addictive, and anytime you use alcohol to treat chronic pain you risk withdrawal, tolerance, addiction, and many other nasty side effects. – Quadell (talk) (bounties) 18:29, 7 September 2006 (UTC)

Fibromyalgia and dopamine agonists
This article contains no mention of the recent theories by Dr. Andrew Holman in Seattle and Dr. David Dryland concerning the positive impacts of dopamine agonists such as Mirapex and Requip on fibromyalgia. Dr. Holman's medical journal articles are from 2000 I think, Dr. Dryland's book from 2005.

Just seems like a gap in article quality.

Additionally, current trials such as Dr. Bennet's at OHSU on low IGF and low cortisol levels in fibromyalgia aren't mentioned....

I have fibromyalgia and am just trying to get a handle on the literature as well as the leaders in the field. I know that there are many competing theories out there, but this article didn't cover them all. I'm happy to help write up the most recent info. someday, though it would require significant research to be able to cite sources properly etc. --Aunt Amanda 06:24, 24 October 2006 (UTC)

Provigil as a treatment for brain fog and fatigue
It'd take some time on pubmed etc. to find the studies, but on the fibro blogs provigil (modafinal) is showing up as a treatment for fibro fog and fatigue. Just a research lead in case anyone wants to follow it up. --Aunt Amanda 06:43, 24 October 2006 (UTC)

Treatment section strikes me as not particularly objective
There are a number of treatments which are presented as either commonplace, accepted, or promising that are, in my experience as a physician, without substantial, reliable supporting data. These include: The guaifenesin protocol, dietary supplements, "managing blood sugar", biofeedback, etc... In addition, in reference to the last lines of the article, I can assure everyone that there are no "blood tests" for this condition.Royalewithcheese2 01:14, 5 December 2006 (UTC)

Misleading and biased article
This article is skewed towards skepticism about fibromyalgia, despite that fact that it (and CFS/ME, related conditions) are recognised by the WHO as neurological conditions.

As a sufferer, I am appalled by the negative way in which this illness is represented here, with much more focus on 'skeptical' views (which are in a minority in the medical community) than on the enormous body of research and medical experience which shows it to be, in all likelihood, a severe and debilitating condition with neurological causes.

Furthermore, the dopamine theory has much more research behind it than this article suggests.

I suggest that Wikipedia needs a specialist in the condition to re-write this article entirely. The vast majority of rheumatologists not only believe in this condition but also know a great deal more about it than is represented here. —The preceding unsigned comment was added by 62.31.54.36 (talk) 16:56, 28 January 2007 (UTC).
 * I can't see what you're talking about. I've read the article and, if anything, it's not sceptic enough. Only in the introduction the word 'psychosomatic' is mentioned and it doesn't return until the 'skepticism'-section, which is only 7 lines in length! On the whole, the article treats FM as an organic disease. Scepticists being in the minority (which I doubt) isn't a reason to make this article SPOV.
 * Furthermore, recognition by the WHO doesn't mean the disease can't be psychosomatic! Not so long ago, the DSM included homosexuality as a disease. Does that mean it was, at the time, really a disease? Of course not.
 * - Troy 12:06, 31 January 2007 (UTC)

I have found a very interesting page where people with Fibromyalgia can learn about Fibromyalgia Self Care and appropriate exercises, I am posting that on the external links since I didn't find any related link for that. I hope people find it very useful and would appreciate the other users opinion Thanks —Preceding unsigned comment added by Chirostudent (talk • contribs)

Contradiction here?
Hello, I'm rather new to the world of Wiki, so please be patient with me if I trip over the occasional shibboleth.

I noticed in this article that in the second paragraph we have the phrase "The disease itself is neither life-threatening nor progressive....", and yet in the third paragraph we find "For example, in some cases it is progressive..."

Might it be worth finding a form of words that avoids a fairly clumsy (apparent) contradiction?

Bytebro 15:09, 7 February 2007 (UTC)


 * I've never heard that fibromyalgia can be progressive. I'm going to put a on that claim and if no one can provide a reference, remove it in a few days. Rosemary Amey 18:47, 7 February 2007 (UTC)


 * I believe that it should be removed (and have removed it for now), as well as the part about it being impossible to generalize about fibromyalgia - at least until it can be rewritten. The author appears to be talking about secondary fibromyalgia (as opposed to primary fibromyalgia), which is fine, but it should be somehow noted there to distinguish it from primary fibromyalgia since normally when people talk about "fibromyalgia" they mean primary fibromyalgia and not simply the symptoms of other known diseases. AliaGemma 03:13, 8 February 2007 (UTC)

Counter Arguments
I have just removed the counter-arguments section, as the "references" given at the bottom had nothing to do with the "counter-arguments". The counter-arguments talked about how treating depression didn't cure fibromyalgia. However the references talked about genetic predisposition and brain abnormalities in fibromyalgia patients and had nothing to do with depression.

I also noticed that there is no mention of PTSD in this article, even though multiple studies over the past 3 years have linked fibromyalgia with PTSD. I'll write up a section about this in the next few days.

This article still needs a helluva lot of work. There is still an awful lot of crud here and not much science.

--Sciencewatcher 05:22, 8 February 2007 (UTC)


 * For the record, the references are for the entire page, not the "counter-arguments" section, which is under the larger skepticism section. It was meant to address skeptics who believe that fibromyalgia is just depression.  While it does need citations, I believe that it might have been cut too soon, seeing how most of it does not seem to be very contentious.  However, seeing how the skepticism section no longer says how some people believe fibromyalgia is depression, that specific counter-arguments section has more or less become irrelevant anyways.  I do think a new counter-arguments section, focusing on the skepticism given, would be appropriate and even needed. AliaGemma 07:39, 13 February 2007 (UTC)


 * I don't think anyone believes that FM is depression. Depression is just a symptom - people with FM might or might not have depression. FM is a syndrome with a number of symptoms. The skepticism is related to whether FM is an organic or psychiatric illness. Most of the evidence points to FM being a psychiatric/psychosomatic illness caused by stress or trauma. That is to say, it is a real illness with real physical symptoms (primarily pain), but caused by stress. --Sciencewatcher 23:08, 13 February 2007 (UTC)

Fibromyalgia and sleep disturbances
Often it's witten that fibromyalgia can be due tue a sleep disturbance, in particular alpha-wave itrusion into deep sleep (stage 4). I found a very interesting article on PubMed written more than 10 years ago which found that ". The alpha NREM sleep anomaly is present in only a small proportion of patients with fibromyalgia. It does not correlate with disease severity nor is it affected by treatment with amitriptyline." Full article here:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=7575714&query_hl=30&itool=pubmed_DocSum

Any ideas about this?

81.208.118.74 11:28, 8 February 2007 (UTC)

My sleep dysfunction was what helped led to my diagnosis. I have had good results from (low) does of Amitryp, in sleep function and related ease of symptoms.

Dopamine
Just a note to explain why I have removed the sentence about dopamine in the introduction. First, dopamine is covered later in the article. Second, the reason for that sentence was to counter the argument that FM could be psychosomatic, but the sentence does not do that. Dopamine is a factor in depression and the placebo effect, so the fact that there are dopamine abnormalities in FM does not really have any bearing on whether FM is psychosomatic or not. A recent study showed that Parkinson's patients receiving a placebo had significant improvement in symptoms and in their dopamine levels. If you want references, let me know. --24.64.32.57 22:57, 13 February 2007 (UTC)

Incidence
"Fibromyalgia is seen in 3% to 6% of the general population"---there's no source... in this article it says it's 2%: http://www.aafp.org/afp/20070715/247.html (es_uomikim 18:29, 16 August 2007 (UTC))

I think that the source should indicate to which population it refers. I am not knowledgable about this condition but it is generally of interest to me to be able to distinguish between trends that may be borne of social, econmic, genetic influence.

--13:15, 21 November 2007 (UTC)Gandru (talk)

"Marijuana, the Wonder Drug"
Finally ethical professionals are standing up: http://www.iht.com/articles/2007/03/01/opinion/edgrinspoon.php Nice quotes: "Neuropathic pain is notoriously resistant to treatment with conventional pain drugs. Even powerful and addictive narcotics like morphine and OxyContin often provide little relief. This study leaves no doubt that marijuana can safely ease this type of pain." "If marijuana were a new discovery rather than a well-known substance carrying cultural and political baggage, it would be hailed as a wonder drug." Lester Grinspoon, an emeritus professor of psychiatry at Harvard Medical School, is the coauthor of "Marijuana, the Forbidden Medicine." It's time this option were legal -- because some of us have no alternatives left. Step up and send this article to your congressional reps. [/end soapbox, pep_rally, PSA] Can someone work this stuff into the article? There's a lot more research on this treatment that can be added as well -- though most of it is research by pharmaceuticals trying to cash in. --Renice 06:25, 3 March 2007 (UTC)


 * No specific reference to fibromyalgia - not suitable for inclusion. WLU 16:15, 26 June 2007 (UTC)

It is also not an effective treatment for some as it has been tested with no pain alleviation, at least in my case.Correctwiki 19:46, 28 June 2007 (UTC)

Lyrica/Pregabalin treatment
The FDA recently approved the use of Lyrica (pregabalin, a gabapentin precursor) for fibromyalgia. This is the first time a drug has actual on-label use for fibromyalgia. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01656.html

I believe some fibro advocates have suggested that someone finally figured out that fibromyalgia might be a lucrative market, and as gabapentin recently went generic, Pfizer wanted a solid market for Lyrica. No one has yet tested whether Lyrics is more effective than gabapentin vs. fibromyalgia, of course.

Regardless of the controversy, the FDA approval should certainly be added and cited. Feyandstrange 09:34, 28 June 2007 (UTC)

Living with...
Living with the syndrome seems most closely related to treatment, but a consensus is needed (see consensus)

Methadone
hi I found that methadone is a good choice for fibromyalgia. isn't it? http://www.revolutionhealth.com/drugs-treatments/rating/methadone-for-fibromyalgia-syndrome-fms hope that helps  —Preceding unsigned comment added by 87.15.251.2 (talk) 08:24, 15 November 2007 (UTC)

All theories should all have verifiable references, preferably medically sound and researched All Wikipedia information should be written from a "Neutral Point-of-View" (see NPoV)

Fibromyalgia as Severe TMS
The diagnosis of TMS (tension myositis syndrome) has been used since 1984 by Dr. Sarno of the Howard A. Rusk Institute of Rehabilitation Medicine and his followers to designate a mindbody disorder that causes chronic back, neck, or limb pain that is frequently mistaken for structurally caused pain. Dr. Sarno says on p.62-63 of Healing Back Pain: The Mind-Body Connection (1991) "Typical of these reports is one published in the Scandinavian Journal of Rheumatology in 1986 (Vol 15, p.165) by N.Lund, A. Bengtsson and P. Thorborg titled 'Muscle Tissue Oxygen Pressure in Primary Fibromyalgia.' Using an elegant new laboratory tool, they were able to measure muscle oxygen content with great accuracy and found that it was low in the painful muscles of patients with fibromyalgia."

"What this means for the etiology (cause) of TMS, as I have long maintained, is that fibromyalgia, also known as fibrosis and myofibrositis (and to some as myofasciitis and myofacial pain), is synonomous with TMS. I have treated a large number of patients who came with the diagnosis of fibromyalgia; their medical histories and physical examinations were consistent with severe TMS.  As proof that the diagnosis was correct, they recovered completely."

In his later book, The Mindbody Prescription: Healing the Body, Healing the Pain (1998) in which he expanded the TMS diagnosis to other TMS equivalents based on his long experience at the Rusk Institute, he says on pp 76-77, "I have maintained for years that fibromyalgia was a severe form of TMS. The similarity of my findings to the diagnostic criteria of the American College of Rheumatology reinforces that diagnostic conclusion." "People with fibromyalgia commonly have psychological symptoms as well. They are often anxious and depressed, have sleep problems and suffer from lack of energy." "Since fibromyalgia ia part of TMS, I have seen and sucessfully treated many patients who had been given that diagnosis before they came to me."

In Dr. Sarno's latest book, The Divided Mind: The Epidemic of Mindbody Disorders (2006), he says on pp.21-22, "Fibromyalgia is a medical term that has been around for a long time. For some reason it was adopted by the rheumatology community in the early 1980s and applied to patients suffering pain in many locations in the trunk, arms, and legs.  In fact, it is a severe form of TMS.  Significantly, fibromyalgia patients commonly suffer from other mindbody disorders as well, like headache and irritable bowel syndrome, as well as emotional symptoms including anxiety, depression, and sleep disorders.  When rheumatologists first became interested in people with these symptoms, they were not able to explain what caused the disorder, but they created diagnostic criteria to define it.  That became a kind of medical kiss of death.  The American College of Rheumatology decreed that the diagnosis could be made if the person under examination exhibited pain in eleven of a potential eighteen locations. Since that time, hundreds, if not thousands, of papers have been published describing studies that try, still unsuccessfully, to explain the disorder. Two of these published studies of people with fibromyalgia found that the oxygen levels in their muscles was reduced, confirming the hypothesis that fibromyalgia is a manifestation of TMS, which we've seen is caused by mild oxygen deprivation."

"But the rheumatology community community did not accept the idea of mild oxygen deprivation as the cause of fibromyalgia, and the epidemic continued. By the year 2000 the enormous increase in the number of people with this diagnosis prompted an article in The New Yorker magazine by Jerome Groopman, a professor of medicine at Harvard, in which he noted that there were six million Americans (mostly women) with this disorder of unknown cause and that it appeared to be analogous to the nineteenth-century epidemic of neurasthenia."

"The fibromyalgia story is another tragic example of the epidemic proclivity of psychosomatic disorders when they are misdiagnosed and, therefore, inevitably mismanaged." Ralphyde 02:34, 11 September 2007 (UTC)

Skepticism
Removed skepticism again. This really has no basis. ExpectDelays 00:04, 15 May 2007 (UTC)

Removed skepticism as it is conspicuously missing from other articles with a similar nature to fibromyalgia, if it is to be included, it should be placed under ALL such articles.Correctwiki 07:30, 12 May 2007 (UTC)

So just because other articles are incomplete this article should follow suite? Bravo John E. Average Wikipedia, Bravo! 71.255.146.20 (talk) —Preceding comment was added at 07:44, 30 November 2007 (UTC)

I will also add my $0.02 - Fibromyalgia is commonly debated as even existing - a skeptical point of view is not subjective, it exists and deserves mention. W@ntonsoup (talk) 02:06, 17 February 2008 (UTC)

Indeed, it's commonly debated as being various effects from mental problems, and some even claim it's feigned. It's not a very widely accepted disorer. Tubba Blubba (talk) 02:39, 23 June 2008 (UTC)

Necessity of skepticism section
I am new to this article, though I stumbled here after reading one of the reviews in the New England Journal of Medicine (Vol. 354 No. 9) pp. 983-984, by Nortin Handler M.D. In it he posits a different concept of Fibromyalgia, stating that it may be an over arching faulty diagnosis, More research should be done. Here is a larger quote from him that I include mostly complete as to not take out of context and also provide for those who may not have access to the NEJM. "However, Fibromyalgia is not an opiate-responsive, tissue specific pain state. It is a far more global state of painfulness, where suffering is much more than an overtone. No one "has" fibromyalgia, or "suffers" from fibromyalgia; one "is" fibromyalgia.  What does "central sensitization" mean in such a state? No doubt patients with fibromyalgia have a distintive neurophysiology that supports an altered somatic sensibility and reactivity." and "...They are afflicted with the distinctive neurophysiology of a pathogenetic idea. Such ideas need to be recognized and explained, so that research and treatment focus on neural plasticity as it pertains to complex intellectual constructs.  There is no disease to cure."

Many find faults with the diagnostic criterion set by the ACR as being faulty in logic. The objection is that it is a "...neologism adopted in 1990 by members of a committee who were convinced that no other rubric did justice to the plight of their patients who were suffering persistent widespread pain in the absence of objective pathobiology, but who were characterized for their singular antipathy to being poked in particular sites -- "tender points" -- on their bodies." He goes on to state that the committee may have improperly introduced diagnostic criteria that simply defines those who they felt were unlabeled. "... the members where testing their diagnostic hypothesis on the very patients they used to generate their notion of fibromyalgia -- a classic pitfall in logic." In fact stress and distress can produce similar hypersensitivity. I believe that this type of skepticism should be welcomed into any scientific discussion. Not a derisive skepticism, but one which states that there may be too much of a focus on have "a" diagnosis, instead of the correct diagnosis. I posit that a skepticism section be allowed and furthermore maintained in this article as it has basis in medical community.

Out of respect for all of those who have put so much of their time and effort into this article, I will not make unilateral changes but welcome your input as you have definitely been working with this article for longer than myself. rmosler 04:57, 13 July 2007 (UTC)


 * I agree with User:rmosler. A skepticism section is certainly appropriate.  Go ahead and add it. Ralphyde 06:04, 13 July 2007 (UTC)
 * Some things to worry about are WP:NPOV and WP:OR, particularly undue weight. If Dr. Handler is the minority or if research has not yet been done to confirm his hypothesis, then the most that should go into an article is a single line stating the opinion.  We don't report without sources and we don't report unreliable sources.  WLU 21:33, 14 July 2007 (UTC)


 * Thanks for the quote and your POV about what is derisive and what is not derisive scepticism. I would support your notion - but only if you also include the missing scepticism sections into multiple sclerosis, aids, cancer, autism etc. Unless you are willing to do that I am against it. As for your Doctor Hadler: I am sure it will surprise you, but there is some scepticism about "your" scepticism. (Ralphyde: That's your cue to start screaming at the top of your voice: "NOOO! HADLER SAYS THE TRUTH, THE TRUTH")
 * Hadler has many verbose critics, like http://www.rheuma21st.com/archives/cutting_edge_fibro_wolfe.html As the author has included his own references in published journals we can and will use them to dissect your upcoming so called "scepticism" section with some "counter scepticism".
 * Here is quote: "The thrust of Hadler's fibromyalgia complaint is this. Fibromyalgia does not exist unless we create it. According to Hadler those labeled with fibromyalgia are distressed individuals whose ability to cope is exhausted and whose invincibility is challenged, persons who find their living unsatisfactory, even desperately wanting, and feel the need to describe the lacking. In evaluating this Hadlerian definition of fibromyalgia we should first ask if it is true. Richard Feynman reminds us that "...it doesn't matter how beautiful your theory is, it doesn't matter how smart you are -- if it doesn't agree with experiment, it's wrong."
 * Here is another quote by Robert M. Bennett, MD, FRCP, FACP, FACR, Professor of Medicine and Chairman Division of Arthritis and Rheumatic Diseases, Oregon Health Sciences University, Portland, Oregon, USA(http://www.rheuma21st.com/archives/cutting_edge_fibro_benett.html) about Hadler (who is also being made fun of at amazon for his obfuscating and obscure writing style):
 * "Unfortunately, Dr. Hadler's fanciful prose and philosophizing has not kept up with the wealth of new information on the scientific underpinnings of chronic pain states."
 * Also, you might want to do some googling about the two week old FDA-approval for Gabapentin for fibromyalgia. And while you are at it, rummage through pubmed for fibromyalgia. If you are new to the entire topic do some reading first. The Hadler&Friends-it's-all-the-head ship has sailed some time ago.
 * Finally, you might take a deep breath and meditate (all in your head) about the tremendous harm you are potentially causing to the patient community
 * Hey, don't look at me. I've never even heard of Dr. Hadler.  I only agreed with rmosler that a skepticism section was appropriate.  And you forgot to sign your post.  Ralphyde 20:32, 17 July 2007 (UTC)

Wow, I thought it was a reasonable request, but I apparently touched a nerve. To answer your question about skepticism sections in other disease articles:

There are several for HIV/AIDS.

There is the minority hypothesis in Autism of its origins being related to teratogenic effects from Thiomersal, a mercuric antifugal agent at one time included in the MMR vaccine.

For MS, though not definitive there has been an extreme amount of research into its cause, and through animal models and specifically targeted monoclonal antibody Selective Adhesion Molecule inhibitors such as Natalizumab's potency it has very well supported the notion of T-cell mediated inflammation.

There is also skepticism in regards to ADD/ADHD, whether in being too general a diagnosis or being a organic disorder at all, even with evidence such as PET and fMRI scans.

All that I am saying is that there is (and I will secede that it is possibly a minority) dispute as to whether or not Fibromyalgia is an appropriate diagnosis or if it is simply an umbrella term for neuropathic pain (And to the unnamed poster, neuropathic pain often treated by gabapentin).

I think that some people may think that because I bring up doubts as to the veracity of the diagnosis that I am attacking them. I have no doubt that sufferers of Fibromyalgia are suffering from true neuropathic pain. I just am bringing up an at least minority view of skepticism of Fibromyalgia as a diagnosis. rmosler 02:05, 16 August 2007 (UTC)


 * I think the rheumatological community has pretty much accepted the concept that Fibromyalgia is a blanket term for several conditions -- something I've tried to reflect in the introduction. I'm not sure "Skepticism" is the right wording here, as no one doubts that the individuals are in pain.  "Diagnostic Uncertainty" might be a more appropriate term. Djma12 (talk) 02:27, 16 August 2007 (UTC)


 * Point well taken. I do believe that we agree. As I was describing before, I was just reading through the NEJM and came upon that article.  I was talking with several of my colleagues who seemed to be in agreement about this.  I was just hoping that Wikipedia would have more substance as to that point of view. rmosler 03:16, 18 August 2007 (UTC)


 * Go ahead and add the section in and I'll try to edit it from some Rheumatological sources I can dig up. Regards, Djma12 (talk) 15:16, 19 August 2007 (UTC)


 * Agreed with [User:rmosler]], the article needs a skepticism section; there is a large part of the medical community which finds the whole idea of fibromyalgia troublesome, and that should certainly be reflected in this article. For Fibro sufferers editing the Wiki, this obviously shouldn't be a cause for concern no-one is saying you're not suffering from anything, they are just suggesting that the way your symptoms are lumped together and classified under this rubric might be wrong.jackbrown (talk) 07:38, 15 January 2008 (UTC)

Well, I think the majority of patients who say they have this condition or/and ME are personality disordered and looking for an excuse for their crappy lives. Such states have been around for a long time. Some Victorians took to their beds suddenly etc. What's 100% clear is that the only people who get this have some mug who'll "look after" them. Funny that isn't it? I'll not edit the page but be aware that a majority of the medical profession don't believe in this "disease", no matter what a few academics in the US chasing research funds and positions with big pharma may say. —Preceding unsigned comment added by 202.89.167.125 (talk) 16:34, 16 July 2008 (UTC)

The above paragraph is offensive and unsubstatiated nonsense. I can't help but give evidence which is personal experience - I am diagnosed with fibromyalgia. I am a single mother with no carer but my creative positive life is far from "crappy"- suggest the above resentfull cynicism is indicative of a crappy life. My GP has suggested I write a book about fibromyalgia: because I manage continual daily debilitating pain (for my son's sake); because there is a lack of experiential self help / fibro management resources available ; and because of ignorant hurtful comments like the above. I am currently researching to write my book and I will add a sentence or paragraph about scepticism re: diagnosis but a whole chapter about scepticism of ignorant people re: fibromyalgia as an "invisible" disability.Wickisweeney (talk) 11:02, 2 September 2008 (UTC)


 * I fully concur - the condition is recognized by the US FDA with approved medications on the market (watch your TV). While no nice person would want to inflict a condition on others, the unsigned comment refered to is by someone who does not have this potentially debilitating condition and does not know what living in constant pain is like.  Such hartful language is not appropriate for Wikipedia and bravo to Wickisweeney for standing up to the bully. - Mikebar (talk) 12:24, 3 September 2008 (UTC)

A review of the edit history of the article will reveal why the controversial nature of this diagnosis is missing from the article, and the reason has nothing to do with the validity of sources. I wish you good luck on improving the article. Dlabtot (talk) 17:57, 16 July 2008 (UTC)

I have to jump in here with Wickisweeney, I too am a single mother with fibro. My life is far from easy, but sorry, it is not crappy either. I have no choice but to get out of bed, every day, no matter the pain or exhaustion I feel. I am the sole provider for myself and my daughter. Period. It has become, nearly, my driving force. I will succeed in spite of my illness. I have recently put myself through school and earned a degree that has allowed me to land a much better job. One with benefits, which allows me to seek treatment for fibroyalgia. 65.243.165.82 (talk) 23:18, 3 September 2008 (UTC)Goodle

Well, there has just been a study which shows that one of the most common and successful treatments is a placebo. Since this is not the case with any other disease mentioned here, I think a skepticism section is appropriate as it is with all 	psychosomatic diseases. —Preceding unsigned comment added by 137.193.54.5 (talk) 15:17, 24 October 2008 (UTC)


 * Uh...just so you know, the concept of 'psychosomatic' is itself controversial. I would challenge you to give an example of a clinical disorder that has no basis in organic pathophysiology.  If you believe there are any, then you are a dualist, wch is a philosophical position with freight that you bring to the discussion.  You might consider another position, e.g. that of the biological psychiatrist, wch contends that even psychiatric diagnoses are linked to organic mechanisms, even if the symptoms that characterize them are conceptualized in an abstracted fashion.  Such would be the position of a monist or holist.


 * After you're done thinking about that, please provide us with an operative definition for the word 'real' -- as in, "this is not a real disorder."


 * Have a nice day! 12.178.84.205 (talk) 13:05, 29 October 2008 (UTC)

The "offensive" paragraph is true on one point: really, most doctors don't take fibromyalgia too serious as a disease. Try to look at it from a doctor's perspective. For me, as a doctor, the choice is this: On one hand I can explain there is no disease to be found and perhaps even try discuss psychological factors that contribute to the experiencing of pain. This costs me very much time and energy, because it's usually not what a patient came for. On the other hand I can just give it a name, fibromyalgia for example, perhaps prescribe some drug, in doing so do what the patient expects of me and move on to people with diseases I can objectify/treat. Don't get me wrong, usually i do try being honest to patients with no objective symptoms, but the energy it costs, the angry responses i get and the time it takes me are very discouraging and if one day I don't have much time i might also get tempted to make the diagnosis of fibromyalgia - and feel bad afterward. Pizzaman79 (talk) 01:30, 12 November 2008 (UTC)
 * However bad you may feel afterwards it won't be as bad as the poor sod with FMS is feeling after you gave them the easy option as opposed to the correct option. -- Web H amster  09:50, 12 November 2008 (UTC)
 * You've misunderstood. The Good Doctor is saying that telling 'the poor sod' that he has FMS is the easy option, as opposed to actually trying to find out what is wrong with them. Dlabtot (talk) 19:23, 12 November 2008 (UTC)
 * No I didn't misunderstand, neither was I being critical of the good doctor. I was responding to the very last paragraph and giving a reason as to why the/a doctor should never be tempted to take that option. -- Web H amster  21:46, 12 November 2008 (UTC)
 * Of course, I did not in any way accuse you of being critical of anyone. Nor should disagreement with an editor in any way be construed as criticism of that editor. While I acknowledge that you believe you haven't misunderstood his comment, your responses reveal otherwise, imho. Dlabtot (talk) 04:04, 13 November 2008 (UTC)
 * You are of course entitled to your opinion, although that entitlement does not extend to said opinion being correct. You are in no position to gauge my level of understanding on anything, whereas on the other hand, I am. Therefore I would be grateful if you would extend some good faith and let me determine what I do or don't understand. I am also in the unique position of knowing what I meant when I wrote the above. As such you are in no position to second-guess me with your opinion, humble or otherwise. -- Web H amster  12:39, 13 November 2008 (UTC)

Recent edits
Major reworking, have provided reference for genetic predisposition and other contentious sections. Have merged tender points and commented out para on people faking the test for benefit and insurance fraud. Still a work in process.

IANAD but was diagnosed with fibromyalgia this year, although I've had symptoms all my life. I had been previously diagnosed with chronic fatigue fyndrome in 1997 but began to suspect I had fibromyalgia in 2002 when I started getting pain. A lot of sites I've linked to are sites I've found useful. I hope that people who read the article when I've finished editing it will come away with a better understanding of fibromyalgia, and that people living with the syndrome will find information they previously may have missed. Am keeping NPOV policy in mind :-) redcountess 00:36, Dec 27, 2004 (UTC)


 * My doctor told me that the theory that it is psychosomatic has been thrown out the window and that it is widely accepted to be mostly genetic. I will try to find references for this, because it's insulting to those of us with FM to imply that we are "making it up," or could "get over it" if we just tried hard enough. Also, there have been recent studies in the use of Cymbalta for controlling FM pain, and it is a drug currently prescribed by doctors for that purpose. I'm not sure where that would be added. Arinna 16:01, 7 June 2007 (UTC)


 * You're responding to a comment that is 2.5 years old, you might want to make sure that the above is still an issue on the page. WLU 18:20, 7 June 2007 (UTC)


 * I put it under recent edits because that's what it was. I must have misunderstood the correct procedure. Yes what I mentioned is still an issue, because one of the first things it says is that "some physicians believe that it may be psychosomatic or psychogenic". —Preceding unsigned comment added by 75.160.96.177 (talk • contribs)


 * It's not the best title for the section, as 'recent' does change. WP:TALK guidelines suggest new comments should go at the bottom of the page, though your understanding of the situation is valid and makes sense.  If you've got sources, by all means put them it, it'll definitely improve the page!  The Cymblta info would go in Treatment However, if you are the user who added the caffeine comment, note that if you don't have a source beyond personal experience, that's considered original research.  WLU 20:19, 7 June 2007 (UTC)


 * Please tell me what the caffeine comment was. I just learned I have FM, and just discovered that drinking lots of Coca Cola causes my body to "feel better" - it could be the caffeine. Do you also feel better by drinking Coca Cola? Phikzd 23:48, 11 August 2007 (UTC)

Why was the section about disability removed?
I remember seeing a section about this a couple months ago on this page -- who removed it and why? A number of FM patients are disabled as a result of the disease. The Social Security Administration (U.S.) acknowledges fibro as a disability, however, only pays support for those with severe cases (i.e. bedridden for months at a time).

It really seems to me like someone came to this page with an agenda...

--Meg 15:14, 27 June 2006 (UTC)

Meg, Let me guess, you yourself have FM and now ASSUME someone else has an "agenda" against you? Geesh. You just confirm why so many MD's doubt that FM is physical, but instead may be a psychological disorder that should be seeking psychiatric help for better resolution of symptoms.


 * Some MD's doubt FM isn't a physical disorder because they are basing their opinions on outdated research (mostly a lack thereof). Many disorders go through a phase during which people wonder if they are real or not.  While there is a ton of good, solid research that now shows that fibromyalgia is real, it takes time for people to become aware of that research.  Doctors are human and they already have a lot to do.  Most don't have time to do much research of their own, particularily if it is about a disorder not directly a part of their field.  Therefore, it is not surprising that many doctors have not for some reason made themselves more knowledgeable about one of many disorders.  They are, however, less common than they used to be.  The question that you should be asking is why so many psychologists and psychiatrists do believe that fibromyalgia is a physical problem!  I have seen a few personally to ensure that there was not such an underlying issue and they all agree that I am mentally sound and that there is nothing they can do for me, so I hope you will their and my word for it.     Another question for you - how come people with fibromyalgia are not cured (or treated to the point of normal or near normal function) by psychiatric help or drugs if it is a psychiatric disorder? AliaGemma 04:12, 25 January 2007 (UTC)

That's a pretty rash conclusion. No, I do not think someone same to this page with an agenda. Rather, I believe someone came to this page grossly misinformed. It is no secret that there are indeed quite a few medical professionals who edit topics on Wikipedia. It is also no secret that there are many medical professionals who are completely ignorant to the true nature of this disease. To exclude a section about disability in an encyclopedia article about a disease that is a disability and disables people to the point where they file (and win) SSDI claims, to me, is irresponsible. Meg 17:59, 8 June 2007 (UTC)

Bias section
The following absolutely had to be deleted...


 * Because the nature of fibromyalgia is not well understood, some physicians believe that it may be psychosomatic or psychogenic. Although there is no universally accepted cure, some doctors have claimed to have successfully treated fibromyalgia when a psychological cause is accepted.

This is biased, incorrect, and violates neutrality. Meg 18:09, 8 June 2007 (UTC)


 * Dear Meg, The statements you have deleted are absolutely true and are cited. Some physicians do believe fibromyalgia is psychosomatic, and they are the ones actually curing people who have been diagnosed with fibromyalgia.  Dr. Andrea Leonard-Segal, who is quoted in the section you deleted, is a board certified Rheumatologist and internist, and a Clinical Professor of Medicine at George Washington University Medical School, and she treats patients at the Center for Integrative Medicine at George Washington University Medical Center.  She is one of eight separate physicians in the above cited book who believe that fibromyalgia is psychosomatic.  Dr. Sarno has been curing such patients since 1984, but only if they can accept that their disorder is psychologically or emotionally caused.  If they cannot accept that, however, they remain in pain. You are the one who is biased, because you cannot accept that possibility.  Have you read the book, Freedom From Fibromyalgia: The 5 Week Program Proven to Conquer Pain?  The authors, Dr. Nancy Selfridge and Franklynn Peterson, both cured themselves of fibromyalgia by using mindbody techniques, and are now curing others.  This is the new paradigm, and you are shutting it out.  We had this discussion before in the section on "Fibromyalgia as severe TMS."  I wish healing for you, which is now possible, if you can only open yourself to that possibility. Ralphyde 20:31, 8 June 2007 (UTC)


 * It reads fine to me and is sourced. Some physicians probably do believe it is psychogenic, and some claim cures.  Doesn't say or even imply that it is a purely psychogenic, only that some doctors believe it to be so.  If it's true, and there is a source to say some doctors believe it so, it deserves to be in the article.  It does not mean that it's true and it's not phrased that way, so I don't see the problem.  WLU 01:32, 9 June 2007 (UTC)


 * The statement does not belong in the opener, it belongs in a section about etiology.
 * If the statement were to remain in the opener, it would be in violation of undue weight, as there are plenty of other theories, some of them stating the complete opposite.
 * If the statement is edited into the opener again, there must be at least one statement at the other main theories about etiology in order not to violate undue weight - which would be a very ugly solution.
 * The sourcing is in my view at best doubtful, as medical articles have to live up to higher standards (One Book, as somebody else stated is not good enough).
 * I would prefer Ralphyde to find another place for his statement than the opener.JayEffage 15:49, 26 June 2007 (UTC)


 * Oops, I retract aspects of my previous statement - the info should go in the article, but should definitely not go in the intro. It should be as you said in the treatment section; placing it in the intro does indeed give it undue weight.  I'll replace it once I'm done archiving.  WLU 16:25, 26 June 2007 (UTC)


 * Totally agreed, glad someone else could see what I was getting at. Thank you very much for making the change! Meg 19:43, 31 October 2007 (UTC)

72.205.223.253 (talk) 18:33, 5 March 2008 (UTC) i am only 14, but i have had fm since i was 8. I may still be young, but i am already worried about being able to keep up a job when i am older. Right now, i cannot go to school, so i have to be homeschooled. Yet it hurts to eeven hold a pencil. I hope, if needed, i will be able to get a disablity check. this section needs to be on here!


 * Please see Living with fibromyalgia and the External links section. If you have other specifics on how the article needs to be improved, you may edit yourself if you feel qualified, or post more suggestions to the talk page for help. Thanks for the input. Ward20 (talk) 19:07, 5 March 2008 (UTC)

Contradict tag
The statement: "The cause of fibromyalgia is currently unknown." contradicts this from Bianca Trump: "However, in late 2001, her silicone breast implants ruptured, causing fibromyalgia and they were removed." Mdbrownmsw 14:07, 14 February 2007 (UTC)


 * I don't see how there is a contradiction. Ruptured breast implants appeared to cause fibromyalgia in one woman. However other women who have had ruptured breast implants did not get fibromyalgia. Therefore there is no reason to think that rupturing breast implants cause fibromyalgia. Maybe it was the stress which triggered the fibromyalgia. I think the contradict tag should be removed - it is inappropriate here. --Sciencewatcher 16:38, 15 February 2007 (UTC)


 * As the neccessary edits (a mention with references in "other theories") have been done, and there is no no contradiction at all, the tag has been removed. LinaMishima 01:02, 16 February 2007 (UTC)


 * Sciencewatcher is close. The contradiction was that the fibromyalgia article said the cause was unknown while the Bianca Trump article said that her fibromyalgia WAS CAUSED by ruptured implants. Even with the addition to this article of the now disproven claim, there was a conflict, as this article says only that some CLAIM there is a causal link. I have made one additional edit to the Bianca Trump article, making it clear that some have SPECULATED that the ruptured implants caused the fibromyalgia. Previously, it said the rupture DID cause fibromyalgia, which is unproven.  Mdbrownmsw 21:47, 19 February 2007 (UTC)

Add a new external link Hello I would like to add a link to the Fibromyalgia Support Group for Surrey and Sussex at www.fibromyalgia-south.com. This website is not only about the support group but also gives valuable information about fibromyalgia and has a fantastic links section. The group runs many activities to help members and keep them up-to-date with the latest developments. They will also help anyone thinking of starting a support group or collaborating with an existing group. Thanks Ralees 11:15, 29 March 2007 (UTC)

question Mdbrownmsw, if a ruptured breast implant was the cause, why then, have I been diagnosed with the illness, yet have never had any augmentation done?````Goodle 16:30 3 September 2008

Review
Narrative review on pathophysiology http://www.annals.org/cgi/content/abstract/146/10/726?etoc JFW | T@lk  07:25, 15 May 2007 (UTC)

Wikisorting
I've had a go at upgrading the valid references. Those that were from blog sites, or self admitted as giving opinions not accepted by anyone else I've removed (under WP:NPOV trivial opinions should not be mentioned at all). Several of the references were duplicates. Some of the references were reports of specific research papers, and so I have given these references with then the explanatory lay article added in the style suggested by Template:Cite journal. On moving out the drugs under research from those currently used, it was apparent that antidepressant/anti-epileptic groups mentioned in a duplicate manner - I've coalesced these to individual paragraphs. David Ruben Talk 01:40, 1 June 2007 (UTC)

Theory credit
As the author of the mucus/inflammation/toxin & colon/sinus/dehydration theory, I would like to add my name for credit, Gene Brock. I also think chronic fatigue syndrome is related. Check my IP address and the original posting.


 * I have left a message on this user's IP address talk page. Please do not add original research to Wikipedia, see WP:NOR. All the best. Mmoneypenny 07:44, 22 June 2007 (UTC)

Disputed section
An anon IP has been attempting to replace the following section on the page. I think it's bogus. Some physicians is weasely and there's no citation. It's not particularly well written and contains original research (in bold). The immune support referene is spammy and contains no actual references. WLU 14:06, 1 July 2007 (UTC)

''Some physicians do not acknowledge there is an organic cause of fibromyalgia. They say fibromyalgia is merely a label for psychosomatic patients, along with diseases such as chronic fatigue syndrome and irritable bowel syndrome. Fibromyalgia has also been called a "wastebasket" diagnosis, usually meaning that the doctor does not acknowledge real pathology or consistent disease. This should not be taken to mean that the symptom complex of fibromyalgia does not exist, but rather that they do not have a somatic cause. At present time, few medical authorities believe that depression and psychological factors (like hypochondria) are the root cause of the syndrome.''
 * Skepticism


 * "This isn't a disease, it's merely a description of symptoms... We've taken stress, psychosocial distress and pain and the ordinary life experiences some people have and turned them into something they're not -- a physical illness"


 * -- Dr. Fred Wolfe, a skeptical Rheumatologist who helped define the disease earlier in his career Article from Immune Support.

Human Growth Hormone
People with fibromyalgia fail to produce sufficient HGH and treatment with HGH alleviates many symptoms. This is key to low IGF, low cortisol levels, high levels of neuropeptide Y, etc.

I'd like to add some of this info. Anyone else here care to help? --68.228.47.100 02:48, 16 July 2007 (UTC)

Leonard-Segal Edit War
To Pacula and Ralphyde: I haven't had enough time to examine the veracity of the source in question, but it doesn't look like spam on first inspection. If the respective editors could give some rationales on why they believe this source should (or shouldn't) be included, perhaps we can avoid an edit war? Djma12 (talk) 23:49, 10 September 2007 (UTC)


 * Thanks for your post. Pacula has been on a rampage, deleting anything related to psychosomatic medicine.  I have been trying to restore things to the way they were before his destructive editing, but he follows me around deleting anything I fix.  The source is verifable and relevant.  Ralphyde 02:17, 11 September 2007 (UTC)


 * Please don't take this the wrong way Ralphyde, but my reversion is not necessarily a support of your view -- I was merely trying to prevent an edit war. Would you mind justifying why you believe the source is relevant and verifiable? Djma12 (talk) 02:40, 11 September 2007 (UTC)


 * I've added a talk section on "Fibromyalgia as Severe TMS" above, which used to exist but was removed some time ago. It's a legitimate theory, proven by the fact that many people have been cured of their fibromyalgia using mindbody treatments.  Dr. Andrea Leonard-Segal is a board certified internist and rheumatologist, and is a Clinical Professor of Medicine at GWU Medical School, and helps people overcome pain at the Center for Integrative Medicine at George Washington University Medical Center.  She was cured of her own chronic back pain by Dr. Sarno using his mindbody method, and said in her article, "A Rheumatologist's Experience with Psychosomatic Disorders", "thus began the most profound and rewarding medical education that I had experienced both personally and professionally.  This education became a new pathway to benefit patients in a simple, noninvasive, and confidence-building way."  She adopted his methods and ended her article by saying, "The beauty of the TMS diagnosis is that it is a hopeful one that can result in a true cure.  The treatment leads to resumption of full physical activity, the emergence of a more emotionally healthy life, and an education in self-awareness.  The patient who has recovered from TMS grows into a happier, more comfortable, more peaceful person who sees new paths toward greater personal fulfillment."  The article is verifiable through the Amazon.com "Search inside" feature.  I hope this helps.  Ralphyde 03:20, 11 September 2007 (UTC)
 * Do you have any sources that fit V criteria? www.pubmed.org is a good place to start.  The book from Amazon is self-referencing and the additional information is original research. Djma12 (talk) 03:30, 11 September 2007 (UTC)


 * My reasoning seemed valid at the time, but I'm not quite as sure now - would be grateful for a little bit of third-party input on the matter. Simply put, I removed this, along with a large number of others, because it was refering (directly or otherwise) to an extremely non-NPOV article (Tension myositis syndrome) on a WP:Fringe subject that basically read like an advertisement for the books it used as reference. Most of the references to this article/advertisement seemed barely relevent, so I thought it best if I tried to sweep up the mess as much as possible. - Pacula 04:57, 11 September 2007 (UTC)


 * Given the tenuousness of the diagnosis, and the complete lack of acceptance for TMS in the mainstream medical community, the mention should be pretty minimal in my mind. Adding anything referenced by Sarno's books (beyond the diagnosis and potential link) is out as far as I know; it'd have to be peer-reviewed journal stuff in my opinion.  WLU 00:36, 14 September 2007 (UTC)

Link
User:Taylor423 is attempting to add a support site to the page. I don't think it's necessary. What do other contributors think? The DMOZ link has a list of 20 support groups, and this isn't adding any reliable information to the page in my opinion. Here's teh link:

WLU 16:32, 18 October 2007 (UTC)

Fybromyalgia
I have fibromyalgia. I am wanting to know if anyone else with this condition has other disabilities? I have arthritis, bursitis, osteoporosis, scoliosis, and bone spurs on my spine. The symptoms with Fibromyalgia are so painful and debilitating. Then add all the other conditions puts my life almost at a stand still. I don't have any energy to clean our home, let alone hold down a job(which I can't do). Excercise lays me up for days, just climbing stairs is a feat in itself. Is there any out ther that would like to share information with me concerning these conditions? It would be greatly appreciated. Thank You. CCradick CCradick 02:09, 28 October 2007 (UTC)

I am a woman with all these conditions and I just turned 48 yrs. old. So you can see how upsetting it can be with all this to deal with on a daily basis. Thank You again.CCradick 02:13, 28 October 2007 (UTC)


 * CCradick, there are many support forums on the Internet for this... I don't think this is the right place to post something like this! I will take another look at the article and maybe add an external link to one of the support forums... I feel that is appropriate and would be a beneficial "add". Meg 19:43, 31 October 2007 (UTC)


 * Meg, well excuse me for trying to have a converstion about my conditions and asking if anyone else had problems other than fibromyalgia. You go ahead and find other support forums. But you shouldn't get so crappy to someone like me considering it was only my second or third time making edits. I'm just learning about things here at Wikipedia. So, before getting an attitude, you should have already found those other support forums before replying to my edit. Also don't wait so long to tell me or anyone else we or our conversations don't belong in this area of discussion71.114.202.6 22:10, 3 November 2007 (UTC)User:CCradick Nov.3 2007


 * There is a clear header at the top of this talk page reminding that "This is the talk page for discussing improvements to the Fibromyalgia article. This is not a forum for general discussion about the article's subject.", see WP:NOT (also whilst I agree Please do not bite the newcomers, also Assume good faith is required). David Ruben Talk 02:52, 4 November 2007 (UTC)


 * Forums and support groups are generally not approproate, unless the article is about that group or website itself. See WP:External links, for Wikipedia is not a directory or listing service (can always Google for support groups). David Ruben Talk 01:27, 1 November 2007 (UTC)

Methadone
hi I found that methadone is a good choice for fibromyalgia. isn't it? http://www.revolutionhealth.com/drugs-treatments/rating/methadone-for-fibromyalgia-syndrome-fms hope that helps —Preceding unsigned comment added by 87.15.251.2 (talk) 08:59, 14 November 2007 (UTC)


 * I'm sure heroin or crack would be, too, but I don't think having people take dangerous, addictive drugs is a good solution to this illness.Ndriley97 (talk) 23:10, 18 January 2008 (UTC)

talk page changes
I removed some of the single-equal sign headings, they screw up the formatting and don't appear to help. WLU (talk) 19:46, 3 January 2008 (UTC)

Several clinical entities?
Fibromyalgia may actually be composed of several clinical entities, ranging from a mild, idiopathic inflammatory process in some individuals, to a somatoform disorder resulting from clinical depression in others, with probable overlaps in between.

While sourced, this seems a very strange statement to me. It is certainly not in accordance with the WHO classification. Secondary depression is always possible, but a mix of a distinctly physical and a distinctly psychiatric condition exceeds my imagination. Most likely, there is something wrong here with the patient selection. Guido den Broeder (talk) 10:54, 25 December 2007 (UTC)


 * It does indeed fit w/ WHO criteria as the classification for fibromyalgia is that of a syndrome rather than a disease. In clearer terms, fibromyalgia is a term used to describe a constellation of clinical signs.  They may stem from a single clinical entity (as in AIDS w/ HIV) or could be several clinical entities who exhibit similar symptoms (as in toxic shock syndrome and many different species of bacterium.)  Djma12 (talk) 23:19, 3 January 2008 (UTC)


 * You forget that it also has a classification code, which puts the diagnosis under a heading (see the link to the ICD10), which excludes entities like the psychiatric ones mentioned. Guido den Broeder (talk) 11:36, 4 January 2008 (UTC)


 * Sure, but ICD coding is for medical billing and insurance purposes only. From a pathophysiology standpoint, the underlying mechanism(s) for disease has not been elucidated. Djma12 (talk) 22:28, 4 January 2008 (UTC)


 * The ICD is far more than that (the medical billing purpose is only a USA thing, I believe). The classification reflects, or is supposed to reflect, the consensus among scientists and clinicians. Anyway, the lead should not contain a statement that is not widely supported. It could be moved to another place in the article, perhaps. Guido den Broeder (talk) 12:21, 5 January 2008 (UTC)
 * Untrue, the ICD coding is only used to have an international code for doctors and computer systems to communicate. Furthermore, fibromyalgia is under the ICD code for Rheumatism, unspecified, so I don't understand why you find the "unclear etiology" statement to be contradictory to the WHO classification. Djma12 (talk) 14:28, 6 January 2008 (UTC)


 * OK, I have moved some stuff to a new section 'proposed causes and pathophysiology'. Guido den Broeder (talk) 13:17, 5 January 2008 (UTC)
 * Moved the main section on causes to that point. Noticed some hidden treatment info, so not happy yet. Guido den Broeder (talk) 19:58, 5 January 2008 (UTC)
 * The citation provided reflects a consensus statement from the American College of Rheumatology, so I am confused on why you believe it is speculative and controversial. Djma12 (talk) 04:09, 6 January 2008 (UTC)
 * Perhaps because it is not based on evidence, and contradicts the WHO classification? Guido den Broeder (talk) 10:13, 6 January 2008 (UTC)
 * I am the one supplying cited text, so the "not based upon evidence" is a little specious. As stated above, it does NOT contradict WHO classification.  Here is the exact WHO classification.
 * M79 Other soft tissue disorders, not elsewhere classified
 * M79.0 Rheumatism, unspecified
 * Fibromyalgia
 * As you can see, the WHO also classifies is also unclear on the etiology for fibromyalgia. Djma12 (talk) 14:06, 6 January 2008 (UTC)
 * Somatoform disorders and clinical depression are, however, not in this chapter. Guido den Broeder (talk) 14:32, 6 January 2008 (UTC)
 * It's not a chapter. It's an ICD subheading. Djma12 (talk) 14:42, 6 January 2008 (UTC)

Please refrain from deleting well-cited text from internationally recognized Rhematology journals just because you do not like them. The information is relevant to the introduction and is well established within the medical community. If you have a problem with the statement, then produce a citation that backs up your claim. Djma12 (talk) 04:06, 6 January 2008 (UTC)
 * Please respect WP:AGF and WP:3RR. Try to finish the discussion first. If you have evidence that the statement is well-established, provide it. Otherwise it should not be singled out to put in the lead. You may have overlooked that the study is already mentioned in the causes section. Guido den Broeder (talk) 10:06, 6 January 2008 (UTC)


 * Do you have any citations to support your statement? You know, I think we need outside input on this.  I'm applying for comment. Djma12 (talk) 14:06, 6 January 2008 (UTC)


 * I don't need to. Support is needed for a claim that it is well-established. If there is none, then it's just one of many theories. An application for comment may be a good idea. Guido den Broeder (talk) 14:35, 6 January 2008 (UTC)
 * I didn't think it was so controversial:
 * The association or otherwise of the functional somatic syndromes.Psychosom Med. 2007 Dec;69(9):855-9. Review. PMID: 180400
 * Comorbidity of fibromyalgia and psychiatric disorders.Curr Pain Headache Rep. 2007 Oct;11(5):333-8. Review. PMID: 17894922 [PubMed
 * The Effect of Anxiety and Depression on Improvements in Pain in a Randomized, Controlled Trial of Pregabalin for Treatment of Fibromyalgia.Pain Med. 2007 Nov;8(8):633-638. PMID: 18028
 * An integrated model of group psychotherapy for patients with fibromyalgia.Int J Group Psychother. 2007 Oct;57(4):451-74
 * And the list goes on. A simple pubmed search demonstrates that this isn't exactly a controversial statement. Djma12 (talk) 14:41, 6 January 2008 (UTC)
 * None of these articles support the statement. In fact, the second one directly contradicts it by stating that psychiatric disorders can occur secondary to fibromyalgia, i.e. the other way around. That, rather, is the mainstream view. Guido den Broeder (talk) 19:36, 6 January 2008 (UTC)
 * I posted this in response to the RfC below, but I thought it might also be useful here: Are there any sources that contradict Djma12's sources? If so, listing them here would be helpful. Ante  lan  talk  21:16, 6 January 2008 (UTC)
 * I don't see how that could be helpful, since his sources don't support his claim. Guido den Broeder (talk) 22:49, 6 January 2008 (UTC)
 * Please actually read the citations. They are indeed supportive.  Do you have anything to back up your claim other than the fact that you don't like the statement? Djma12 (talk) 02:09, 7 January 2008 (UTC)
 * Once again: try to respect WP:AGF. Guido den Broeder (talk) 09:06, 7 January 2008 (UTC)
 * I know that you are editing under what you believe to be the best for wikipedia, but your posts do not accurately reflect either the medical literature or the citations provided. Pointing that out does not violate WP:AGF. Djma12 (talk) 13:12, 7 January 2008 (UTC)
 * The Rheum Int article supports the claim; the claim is almost a paraphrase of a paragraph from that article. If you have an RS that contradicts this, it would be good to get an alternative view. Otherwise, I don't see grounds for complaint here, unless there is perhaps some misunderstanding of the words used. Ante  lan  talk  04:23, 8 January 2008 (UTC)
 * Well, produce the paragraph and we can have a look. Guido den Broeder (talk) 00:10, 9 January 2008 (UTC)
 * It's the very beginning of the next section, and is what I came here originally to comment about per the RfC. Ante  lan  talk  01:02, 9 January 2008 (UTC)
 * OK, thanks. Guido den Broeder (talk) 01:07, 9 January 2008 (UTC)

Fibromyalgia Intro RFC
Should the following statement from Rheum Int be included in the intro?

"Though recognized as an independent clinical syndrome, the pathophysiology behind fibromyalgia may actually be secondary to several clinical entities, ranging from a mild, idiopathic inflammatory process in some individuals, to a somatoform disorder resulting from clinical depression in others, with probable overlaps in between. Current diagnostic criteria are insufficient to differentiate these entities."

(http://www.springerlink.com/content/1271314042w8405g/)


 * Yes, that information is relevant to this article, coming from a reliable and pertinent source. If there are contradictory sources, please demonstrate them (either citing them in journal format or, preferably, by providing links to online versions) so that they can also be considered for addition to this article. Ante  lan  talk  17:23, 6 January 2008 (UTC)


 * Yes, But where is any evidence that the somatoform disorder results from the clinical depression? I would rather see "coexisting with" rather than "resulting from," or even "resulting from repressed unpleasant emotions," which could be cited. Ralphyde (talk) 19:00, 6 January 2008 (UTC)


 * A citation would be most helpful. Can you provide it here? Ante  lan  talk  19:20, 6 January 2008 (UTC)


 * I have been unable to find any appropriate citations except those that relate to fibromyalgia as a severe form of tension myosits syndrome, which is known to be caused by repressed unpleasant emotions. However, the Springer reference above doesn't assert that the somatoform disorder in group 4 fibromyalgia results from clinical depression, but that "In the fourth group, serious previous or still existing psychological problems or also insufficient coping with illness symptoms must be regarded as the reason for pain chronification."  Clinical depression was only "associated with" fibromyalgia in groups 2 and 3, as just another symptom, not as a cause.  Therefore, I think "resulting from" should be changed to "coexisting with" or "sometimes associated with."   Ralphyde (talk) 21:33, 6 January 2008 (UTC)


 * I'll use the phrase "comorbid", is that fair? Djma12 (talk) 02:06, 7 January 2008 (UTC)


 * I'm not really happy with the term "comorbid" as I think it implies a "risk of dying" which is not really appropriate with fibromyalgia. I would prefer plainer language as I suggested above. Ralphyde (talk) 06:44, 7 January 2008 (UTC)
 * A comorbidity is a disorder that is associated with another. The word may not be the best for a lay audience so perhaps we should find another, but the meaning should suit you (based on your comments here). Morbidity and mortality are thankfully not the same, for what it's worth. Ante  lan  talk  06:55, 7 January 2008 (UTC)
 * I understand that, but in the Charlson comorbidity index as described in the article on comorbidity, the purpose of the index is to determine the mortality or "risk of dying" for the patient, given the associated diseases. I agree that we should find a better word for the lay audience.  Ralphyde (talk) 01:21, 8 January 2008 (UTC)
 * Fair enough. The language of the section needed to be made more user friendly anyways. Djma12 (talk) 04:03, 8 January 2008 (UTC)


 * Yes, but I would suggest that instead of quoting them, we rewrite it to be a little bit more friendly to the casual reader. Orange Marlin  Talk• Contributions 02:46, 7 January 2008 (UTC)

Thanks for the comments guys. I have implemented the suggestions from above. Djma12 (talk) 04:22, 8 January 2008 (UTC)
 * And I have removed your attempt at implementation, since you did not take into account Ralphyde's comments on comorbidity. Antelan seems to have missed that the theory (which is not based on any evidence whatsoever) is already in the text and voiced no opinion on whether it should be singled out to put in the lead; nor did Orangemarlin. Guido den Broeder (talk) 18:56, 8 January 2008 (UTC)
 * Ralphyde already editted his version into the intro, in fact you just editted it out. I asked whether the statement should be included in the intro and every other editor replied Yes, or Yes with some tweaking.  I am again flumuxed and confused on what you define as "no consensus." Djma12 (talk) 00:00, 9 January 2008 (UTC)
 * Concensus is not the same as a vote, it is based on arguments. Alo, in your presentation of the issue, you forgot to mention that the reference is already elsewhere in the article. Guido den Broeder (talk) 00:06, 9 January 2008 (UTC)

I confess that I'm not well versed in Fibromyalgia, but the source that has been quoted here states that depression is causal in the somatoform variant, not just associated with it. Is there some source that disagrees? I'm asking because of this change. Ante lan  talk  04:42, 8 January 2008 (UTC)
 * There is no 'somatoform variant' of fibromyalgia, and therefore also no literature either way. There is a known pain disorder which could perhaps fall under the header of 'somatoform disorder', but that is not fibromyalgia. Regards, Guido den Broeder (talk) 18:58, 8 January 2008 (UTC)

Let's step back for a moment and see what the abstract of the article actually says:

''As has been shown by a number of working groups, primary fibromyalgia syndrome does not represent a single clinical entity. It is possible to distinguish between a subgroup with high pain sensitivity and no associated psychiatric condition, a second and a third subgroup characterized by depression associated with fibromyalgia syndrome, and a fourth group with somatoform pain disorder of the fibromyalgia type. Mild inflammatory processes must be considered as the cause in the first group, while depression is combined with fibromyalgia in the second and the third group. In the fourth group, serious previous or still existing psychological problems or also insufficient coping with illness symptoms must be regarded as the reason for pain chronification. Group 1 benefits from a blocking of the 5-HT3 receptors by means of tropisetron, for example. This does not only affect pain chronification but also the inflammatory process itself. Group 2 and 3 needs antidepressant treatment, whereas the focus should be on psychotherapy in group 4. Groups 1, 2 and 3 will also profit from multimodal physical treatment programs, to a certain extent this applies to group 4 as well. So-called mixed types require a combination of therapeutic measures.''

So these groups are in fact:
 * 1) Fibromyalgia with inflammation
 * 2) Fibromyalgia with depression (2x)
 * 3) Some somatoform pain disorder resembling fibromyalgia.

In no way does this study therefore imply that there are various fibromyalgia entities. The authors merely confuse the issue by stating that 'working groups' have shown this. In reality, we have a possible cause, a comorbodity, and something that is not fibromyalgia at all. Guido den Broeder (talk) 19:23, 8 January 2008 (UTC)


 * "Somatoform pain disorder of the fibromyalgia type" is considered one of the "subgroups" of fibromyalgia, which "does not represent a single clinical entity." You have interpreted this source to say that the somatoform pain disorder is "not fibromyalgia at all." From my best interpretation of this source, it is not in agreement with you. This is why I'm asking if you have other sources that are. Ante  lan  talk  20:44, 8 January 2008 (UTC)


 * No, it's not. It's a subgroup of somatoform disorders, normally called pain disorder. The source you want is the ICD10. Guido den Broeder (talk) 21:00, 8 January 2008 (UTC)
 * Note, by the way, that if you were right, the label 'somatoform' would not add anything, it would still be generic fibromyalgia. Guido den Broeder (talk) 21:14, 8 January 2008 (UTC)


 * Smacks forehead Guido, why is there no consensus?  We have four separate and well-respected editors who disagree with your uncited interpretation of standard medical literature.  I'll give you two more days to actually find citation, otherwise this is going forward per WP:CONSENSUS. Djma12 (talk) 23:49, 8 January 2008 (UTC)

Be careful with that forehead, you may need it later on. The wall, in this case, is not me, but the ICD10 - the only citation that I need - and the fact that the article does not really say what you put in the lead. I'm not sure how you are counting either. But perhaps these four respected editors could step forward, show where the article finds these various entities, and produce evdidence that this is well-established? Guido den Broeder (talk) 23:59, 8 January 2008 (UTC)


 * Can you quote the exact statement from which you're drawing support for this claim? Djma12 has done so on this page with the Rheum Int article, which was extremely helpful in supporting his position. You will need to do the same, because I have read over the ICD10 and I do not see what you claim is there. Simply quote the line or paragraph that contradicts what is said in the Rheum Int article and we'll be on our way inserting that into the article. Ante  lan  talk  01:06, 9 January 2008 (UTC)


 * I understand now that the above is a literal quote from the article. It makes little difference, since I don't see how you can arrive at Djma12's text from there. What the authors seem to claim in that paragraph is that several conditions may lead to fibromyalgia (and will then continue to coexist), not that they are fibromyalgia. They go on to say that it is not possible to differentiate between these premorbid conditions, i.e. they cannot prove their theory. I still fail to see why this particular theory should be in the limelight. Guido den Broeder (talk) 01:17, 9 January 2008 (UTC)


 * Here's my position: I interpret Djma12's article the same way he has, but that doesn't mean I don't believe you. Your convictions make me believe that there is an article out there that says what you are trying to say here, and it would be a boon to this Wikipedia entry if you could help us find such an article. I mean, I personally would like to read it and help you add its contents to this article. My problem is that I can't find such an article (but again, my failure on Pubmed does not mean I don't believe you, but it does mean that I have to ask you to do the legwork here). Can you do this? Ante  lan  talk  03:00, 9 January 2008 (UTC)


 * I don't think such an article exists. There is, however, other literature on the pathophysiology of fibromyalgia. The article is still very poor IMHO and adding information might make it clear that this particular study is not the golden nugget. Guido den Broeder (talk) 11:53, 9 January 2008 (UTC)


 * OK, that's fine. I have access to a medical library, and I'm willing to verify things if you can give me specific references. It doesn't have to be an article from an archival journal. Specific sources are going to be paramount if you are to achieve what you're looking to achieve. Please direct me to one, and I'll verify it an add the material to the article. By the way, I have access to the full Fibromyalgia article cited by Djma12, and the full text does even more clearly implicate depression as being causal in some types of fibromyalgia. All the more reason to find an RS that disagrees with this if you really don't think this claim is true. Ante  lan  talk  00:39, 10 January 2008 (UTC)


 * Antelan, could you please post the text from the part of the article which shows a causal relationship for depression. I don't think the abstract implied that at all, and I would be surprised, as I think the depression is just another coexisting symptom of a deeper underlying cause. Ralphyde (talk) 04:46, 10 January 2008 (UTC)

Yes, here you go. The quote is below. Please consider my suggestion above (that is, if there is a source to back your thoughts on this, please let me know so I can pull it from the library and cite it here). As requested, here is the paragraph I'm talking about (in full): Whenever fibromyalgia and depression coexist, the question invariably arises whether the latter disorder must be regarded as an associated affection or the actual cause of the chronic pain disorder. A clear-cut answer to that question can be given with regard to bipolar disorders. We were able to demonstrate that the clinical course of fibromyalgia and depression ran in parallel in a number of these cases: While pronounced symptoms of fibromyalgia were present during the depressive phase, they disappeared completely in the manic phase. We also observed such a parallel course in recurrent major depressive disorder. Here, the pain syndrome receded or in some cases even subsided completely when the depression improved, only to reappear again with an aggravation of the depressive disorder. These cases all point to the significant role which depression plays in the development of fibromyalgia in some patients. Ante lan  talk  05:09, 10 January 2008 (UTC)

Thanks. I'd like to know what they consider to be 'pronounced symptoms of fibromylagia', but the above is not about a causal realtionship, only about aggrevation by a comorbidity. That is a normal phenomenon and does not imply multiple fibromyalgia entities. Guido den Broeder (talk) 11:46, 10 January 2008 (UTC)


 * Throughout the text, these authors make it rather clear that they believe that some, but certainly not all, forms of fibromyalgia are caused by depression. For example:

Fibromyalgia patients with depression

As has been emphasized before, it is often virtually impossible in the individual case of Fibromyalgia to draw a clear distinction between an associated depressive mood and a depression as the actual cause of the chronic pain disorder. Therefore, one will invariably begin with low-dose antidepressant medication in every case where fibromyalgia is coupled with depression. These antidepressants exert a beneficial, albeit often only temporary, effect on pain and depressive mood in approximately one-third of the patients in question. However, if depression is actually causing fibromyalgia, it will be necessary to prescribe higher doses of the said substances, possibly in combination with other medications. Apart from that, this group of patients also benefits from physical therapy and psychotherapy. Further studies will have to show whether a differentiation of the proinflammatory cytokines will help to make headway in the medical management of these cases. I'm not saying that I agree with this, or that this is some truth, but they certainly discuss, at various places in the article, fibromyalgia caused by depression. Ante lan  talk  17:29, 10 January 2008 (UTC)


 * ...uhm: what if depressive symptomology and widespread tenderness are both manifestations of an underlying pathophysiological process? That would make the whole cause-effect/chicken-egg/depression-fibromyalgia issue a moot point, wouldn't it?


 * Q: Which causes which -- neuropsychiatric problems or bradykinesia?


 * A: Trick question. We call it Parkinson's disease.


 * Dr. Anymouse (talk) 20:18, 11 January 2008 (UTC)


 * Point well taken. My point has never been that I think these fellows have nailed down the etiology of fibromyalgia; instead, my point is simply that I have seen no source-based objection to their claims. This isn't my source - Djma12 found it, and upon review, I support using it in this article. If there are alternative views, that's fantastic - they just need a source. Ante  lan  talk  21:50, 11 January 2008 (UTC)
 * There are plenty of alternative theories listed alongside this one in the appropriate section 'Proposed causes and pathophysiology'. Guido den Broeder (talk) 14:04, 14 January 2008 (UTC)

As this RFC has only had one dissenting voice, who is the original dissenter, andhe has provided no further citation, I am going to re-include the statement per WP:CONSENSUS by tomorrow (unless Guido can provide an actual article that supports his claim.) Djma12 (talk) 18:55, 12 January 2008 (UTC)


 * And again removed, since the text is not supported by the source. Guido den Broeder (talk) 08:33, 14 January 2008 (UTC)
 * We have supplied 4 separate sources, all of which confirm the statement. We have accomidated your stonewalling for a week and you still have not provided any sources.  This is unacceptable wiki practice. Djma12 (talk) 13:14, 14 January 2008 (UTC)
 * None of them does, as explained above. Statements that are not supported by the provided sources need to be removed forthwith. Guido den Broeder (talk) 13:53, 14 January 2008 (UTC)
 * Furthermore, there is no 'we' here, It's just you. Guido den Broeder (talk) 14:00, 14 January 2008 (UTC)
 * Untrue, we have hashed out, at length, how the citations provided verify the statement. The "we" in the consensus include Me, Antelan, Ralphyde, and OrangeMarlin.  On the contrary, you are the only (and original) dissenting voice.  We have given you time to find sources, even opened an RFC, but the time for stonewalling is over. Djma12 (talk) 14:06, 14 January 2008 (UTC)
 * None of the users you mention have confirmed consensus of any kind, let alone on your text. Guido den Broeder (talk) 15:05, 14 January 2008 (UTC)
 * "Yes, that information is relevant to this article, coming from a reliable and pertinent source." Antelan
 * "Yes..., But I would rather see "coexisting with" rather than "resulting from," Ralphyde
 * "Yes, but I would suggest that instead of quoting them, we rewrite it to be a little bit more friendly to the casual reader." OrangeMarlin
 * Djma12 (talk) 15:09, 14 January 2008 (UTC)

So this is at best 3:2 and Dr. Anymouse disagreeing makes 3:3. Then, you wrote something far beyond what was discussed in the RFC. My source is, as mentioned numerous times, the ICD10. But that is not relevant since you are simply misquoting your own source, and failed to argue why this should be in the lead in the first place. Guido den Broeder (talk) 23:53, 14 January 2008 (UTC)
 * Re Antelan: The information is already in another section of the article. You forgot to mention that.
 * Re Ralphyde: You ignored his amendment, which makes all the difference.
 * Re Orangemarlin: see Antelan.
 * Djma12 has accurately represented of my position. Ante  lan  talk  00:12, 15 January 2008 (UTC)


 * I am willing to add my name to the consensus that Djma12 claims. My interpretation is based solely on the article abstract, as linked and as quoted.  The following seem to be clear conclusions from it:
 * It says, "primary fibromyalgia syndrome does not represent a single clinical entity" -- not that it is a single disorder sometimes confused with others.
 * It refers to the first three distinguished types as "subgroups" and to the fourth as a "group." However, the enumeration 1, 2, 3, 4 obviously implies that the 4 are all to be considered subgroups of "fibromyalgia."
 * It says, " Group 1 benefits from a blocking of the 5-HT3 receptors" and then suggests different therapies for groups 2 and 3 and for group 4. If the authors thought that the other types also benefit from blocking of the 5-HT3 receptors they surely would have said so, rather than implying they don't.  The fact that distinct, non-overlapping therapies are required is strong evidence for differentiating among the types.
 * It says, "inflammatory processes must be considered as the cause in the first group" but does not mention them as causes in groups 2 and 3 or group 4. This seems less strong than the parallel comment about the treatments, but still the most probable interpretation is that the authors intend those two sentences to list distinct and primarily non-overlapping causes.
 * The distinct etiologies appear to correspond appropriately with the distinct suggested treatments.


 * In summary, it seems clear that this citation regards "primary fibromyalgia syndrome" as a group of clinical entities with at least 3 (and evidently 4) distinct etiologies and corresponding treatments.
 * William P. Coleman (talk) 00:38, 15 January 2008 (UTC)


 * What you are skipping is that they also say: "It is possible to distinguish between a subgroup with high pain sensitivity and no associated psychiatric condition, a second and a third subgroup characterized by depression associated with fibromyalgia syndrome..."
 * From this, it appears that they are using a nomenclature different from the usual where they talk about clinical entities in the first sentence, by including comorbidities.
 * The question put to you is, however, not whether this source should be a reference, since it already is, but whether it should be quoted in the lead while a dozen other theories with equally poor evidence are not. Guido den Broeder (talk) 08:44, 15 January 2008 (UTC)


 * Doesn't that sentence reinforce my other points? Namely, the subgroups not only have different etiology and treatment, but also present with different primary symptoms?  Its logic is parallel to the sentences I did summarize and it strengthens them.


 * As for the question you put to me, I got my information from your posts.  That lengthy quote was one of the main supports you used above for your position -- your appeal to reality.  I'm a biostatistician who doesn't initially know anything about fibromyalgia, but I do know a lot about reviewing scientific research.  So, my attitude was, "Who knows?  Perhaps you could be right.  To begin, I'll use your own quotation and, after checking your text against the linked abstract, assess your opinions against what I see there."  Now you're telling us that article is not important, after all? -- Only one of "a dozen other theories with equally poor evidence?"


 * I used to teach philosophy of science. A classic abuse is the way that some people, in order to save their existing opinions, will continually change their responses in the face of evidence and obvious deductions from it.  Rather than using theories to govern evidence, a scientist does the opposite: he uses evidence to critique theory.


 * It's understandable why others have grown impatient with you.


 * William P. Coleman (talk) 13:56, 15 January 2008 (UTC)


 * I have absolutely no clue what you are hinting at. I have not changed my position. Guido den Broeder (talk) 15:54, 15 January 2008 (UTC)

Of course such goobledygook should not appear in the lead. See WP:LEAD: "should be written in a clear, accessible style so as to invite a reading of the full article". However, the lead should clearly inform the the reader of the highly controversial nature of this diagnosis, not hiding or minimizing the reality that a significant percentage of doctors and scientists do not believe that the set of symptoms commonly called Fibromyalgia even constitute a disease. Dlabtot (talk) 17:36, 17 January 2008 (UTC)

Statement needing citation in the intro
Three statements appear in the intro that require citation?


 * 1) Fibromyalgia is seen in about 2% of the general population.
 * 2) Recently there has been an increase in the number of diagnoses[citation needed],...
 * 3) which is assumed to be associated with better identification of the disorder[citation needed].

Can anyone provide citations for these statements? If nothing can be found in the next couple of days, I'll be removing these statements. Djma12 (talk) 04:20, 8 January 2008 (UTC)


 * The American College of Rheumatology says fibromyalgia affects 2-4% of the population. Ante  lan  talk  04:26, 8 January 2008 (UTC)
 * Thanks, I'll put this citation in. Djma12 (talk) 04:30, 8 January 2008 (UTC)
 * Looks like someone already did that, mea culpa. Does any have sources for the other statements?  Djma12 (talk) 04:32, 8 January 2008 (UTC)

Citation Problem
This citation http://www.ncbi.nlm.nih.gov/pubmed/16154700?dopt=Abstract seems to contradict the statements made in the section "physical treatments". —Preceding unsigned comment added by 24.185.220.72 (talk) 05:33, 9 January 2008 (UTC)

I just completed an exhaustive search of EBSCOHost, Emerald, ProQuest, MedLine and Thomson Gale. I can find nothing to support an increase in recent diagnosis. However, with the CDC's recent emphasis on physician education, what would have been a secondary or tertiary ICD-9/10 Dx may be classified as primary. As an 8-year veteran of CFS, a child of a 24-year veteran of FM and an adult with university access to over 90 libraries, please, feel free to pick my brain should further questions arise. As an aside, any pain syndrome will result in depression and vice versa. They are physiologically linked; the prescription medication Cymbalta. However, there is no evidence that depression causes "calcification-like" feeling of FM. It can contribute to the overall general pain. --Cassandra 09:56, 15 January 2008 (UTC)

New article on fibromyalgia and approval of drug
I thought people might want to include the information from here Remember (talk) 15:15, 14 January 2008 (UTC)

Weight
I've read somewhere that a significant majority of sufferers are overweight, shoudln't that be mentioned somewhere here? talonx22:15, 14 January 2008 (UTC)
 * It sounds unlikely. In general, to include something you need a reliable source for it. Regards, Guido den Broeder (talk) 22:26, 14 January 2008 (UTC)
 * It sounds pretty likely, since 66% of US adults are overweight or obese. Probably not encyclopedic, unless the obesity contributes to the pathogenesis or severity of the disease, which it may. Ante  lan  <sup style="color:darkred;">talk  02:04, 15 January 2008 (UTC)
 * The USA house only a fraction of the world population. Guido den Broeder (talk) 10:23, 15 January 2008 (UTC)

The source can be found in today's NY times. 

"The potential for weight gain is a special concern because many fibromyalgia patients are already overweight: the average fibromyalgia patient in the 2007 survey reported weighing 180 pounds and standing 5 feet 4 inches." Djma12 (talk) 02:24, 15 January 2008 (UTC)


 * No cause and effect relationship between fibromyalgia and overweight is posited, if I understand this correctly. It is a given that a large percentage of the American populace are overweight, and that fibromyalgia sufferers share that problem. Being sick and inactive can also lead to more weight gain and an inability to be active enough to get it down again. The concerns related to Lyrica causing "severe weight gain" is a serious matter, which in less serious cases of fibromyalgia might give cause to reconsider whether it is worth it to take it at all. -- <b style="color:#004000;">Fyslee</b> / <b style="color:#990099; font-size:x-small;">talk</b> 06:24, 15 January 2008 (UTC)

This may not even be real
No mention of this: http://www.nytimes.com/2008/01/14/health/14pain.html?em&ex=1200459600&en=bac45d5aff5a17d7&ei=5087%0A

Frederick Wolfe isn't even cited in the article?! Ridiculous... I'm not going to go through the history, but I'm guessing balanced discussion of the controversial nature of this diagnosis has probably been excised many times. Yesterday's article in the NY Times said it quite well: "diagnosing the condition actually worsens suffering by causing patients to obsess over aches that other people simply tolerate". Fibromyalgia is simply a form of hypochondria. Dlabtot (talk) 23:02, 15 January 2008 (UTC)
 * I don't know about that, but it is certainly notable that there are many, including those in the medical profession, who believe this. In fact, it's one of the most notable features of this disorder, deserving significant coverage. Ante  lan  <sup style="color:darkred;">talk  23:06, 15

January 2008 (UTC)
 * BTW, the suffering is no doubt real for most. I don't think malingering is an issue here. In the past, many people were supposedly possessed by spirits or demons.  Their suffering was no doubt real as well. Dlabtot (talk) 23:12, 15 January 2008 (UTC)


 * I agree that Frederick Wolfe should be cited in the article, especially his conclusion:
 * "Dr. Frederick Wolfe, the director of the National Databank for Rheumatic Diseases and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety."
 * “Some of us in those days thought that we had actually identified a disease, which this clearly is not,” Dr. Wolfe said. “To make people ill, to give them an illness, was the wrong thing.” Ralphyde (talk) 02:48, 16 January 2008 (UTC)

Feels pretty damn real to me. Giving it a different name or cause will make no difference to that. -- Web H amster  02:55, 16 January 2008 (UTC)
 * Maybe you should publish an article about your experience in a reliable source. Then, we could cite your subjective impressions in the article and give them all the weight they deserve. Dlabtot (talk) 17:41, 17 January 2008 (UTC)
 * I think her/his expression of pain should be respected, even if it cannot be taken into account as we write this article. Ante  lan  <sup style="color:darkred;">talk  18:34, 17 January 2008 (UTC)
 * This was a talk page for improvement of the Fibromyalgia article. I think comments here should stick to that topic. Dlabtot (talk) 18:58, 17 January 2008 (UTC)
 * If you got your head out of Wikilawyer for Dummies 2nd edition you would see that I was passing comment on the quote with regard to Wolfe's assertion that giving it a name has done us no favours. The last place I would come to for advice or solace would be here. It's quoted here so a comment was made here. Perhaps you skipped that chapter? -- Web H amster  05:58, 19 January 2008 (UTC)
 * Patient experience is relevant and not by definition unreliable, according to the AGREE instrument, the international standard for guideline development. Guido den Broeder (talk) 19:34, 17 January 2008 (UTC)
 * I have no clue what you are talking about. I never said nor implied anything that is in any way related to the question of whether or not "patient experience is relevant" nor did I say or imply in any way that it is "by definition unreliable". WP:FIVE is the standard that applies here. Wikipedia content must be verifiable to reliable sources.  Dlabtot (talk) 20:00, 17 January 2008 (UTC)
 * Pain associated with fibromyalgia can be measured with the Patient Experience Diary. Guido den Broeder (talk) 20:19, 17 January 2008 (UTC)
 * What is the Patient Experience Diary and is this a clinically validated endpoint? Djma12 (talk) 05:38, 19 January 2008 (UTC)

Intro detailing
Now that we've gone into the whole buisness of WHAT should be in the intro, I think the new section could use a substantial rewrite for readability. Any suggestions? Djma12 (talk) 05:37, 19 January 2008 (UTC)

Technical terms difficult for many readers
Added "cleanup-jargon" tag: "This article or section contains too much jargon and may need simplification or further explanation." Explain jargon says: "Explain jargon when you use it (see Jargon). Remember that the person reading your article might not be someone educated or versed in your field, and so might not understand the subject-specific terms from that field. Terms which may go without a definition in an academic paper or a textbook may require one in Wikipedia.

The first time an article uses a term that may not be clearly understood by a reader not familiar with the subject area, such as the terminology of a science, art, philosophy, etc. or the jargon of a particular trade or profession, introduce it with a short, clear explanation that is accessible to the normal English reader or based on terms previously defined in the article.'" Ordinary people may come to Wikipedia to learn about medical problems. They should feel like they understand our article and have learned something, rather than feeling confused and frustrated. I think that this is especially important in the intro section. -- 201.37.229.117 (talk) 12:34, 20 January 2008 (UTC)

Possible mechanism for reported reduced efficacy of opioids for fibromyalgia
I found this study while researching something else, and thought it may be useful to editors of this fibromyalgia article:. - Tekaphor (talk) 14:19, 25 January 2008 (UTC)

Be advised - this is another area where there is extremely divergent opinions. I'll leave Medsearch citations for others. What I can tell you is that I (w/the Dx) attend a famous regional pain clinic where the practice partners disagree re: efficacy of opiates on "fibro" pain. Opiates definitely relieved my pain, at considerable cognitive expense. The opiate agonist, Suboxone, provides less pain relief, but substantially more than nothing. As long as the medical community wants to pronounce me fibromyal-gic (since '87), I expect it to respect my (necessarily) subjective reports regarding pain management. And I'm a hard-core MBSR adherent; you can't do more on one's own to manage pain. Andraste60 (talk) 05:38, 27 March 2008 (UTC)andraste60

Not controversial?
I'm trying to understand this revert by. Fibromyalgia IS clearly controversial, as evidenced by the recent NYTimes article discussed on this page. WH... what is your justification for this revert? Are you claiming that there is no controversy about Fibro? Dlabtot (talk) 20:53, 14 February 2008 (UTC)
 * I'm not claiming anything. I removed it because the lead is supposed to reflect what is in the rest of the article. The article does not cover in any meaningful or substantial way this controversy. If you wish to put in a section about its alleged controversy then feel free, when the rest of the article reflects this so-called controversy then so can the lead. -- Web H amster  23:07, 14 February 2008 (UTC)
 * Well if the article "does not cover in any meaningful or substantial way this controversy" that's sounds like a real problem. What is the reason, in your opinion, that the significant controversy about this alleged disease has been censored out of the article?
 * Although, I must add, I don't agree with your assertion. In fact, the third paragraph of the lead does discuss the controversy, although clumsily.  Dlabtot (talk) 23:17, 14 February 2008 (UTC)
 * Why are you putting words into my mouth? I didn't say it had been censored, I didn't say anything about it having been taken away. I said it wasn't there. You aren't wearing tin foil on your head whilst typing are you? Personally I don't believe "controversial" is the best way to describe it as that gives an impression of heated disagreement. Yes there are different interpretations of the malady, yes there are disagreements over the diagnostic criteria, but the vast majority of mainstream doctors recognise it as an 'official' disease, as do many national health authorities. What I'm saying is that there are mentions of these disagreements in the article, but there is nothing that makes a major deal out of it and uses the terms "controversy" or "controversial", and certainly not to the degree where it could be described as a "controversial disorder". So like I said, please feel free to start a controversy section that makes it clear that it is indeed controversial. Then add it to the lead. Just in case you hadn't noticed my edit was based on the way the article is now, not what it would be like with some 'controversial' meat on its bones. But like I said, I feel that "controversial" is too strong a description, certainly based on how the article describes things. So just what is controversial about it? In your view that is? -- Web H amster  23:52, 14 February 2008 (UTC)
 * My view is irrelevant. The answer to your question "what is controversial about it?" is found in reliable sources like the New York Times, which I'll note, even specifically uses the word 'controversy': "Those figures are sharply disputed by those doctors who do not consider fibromyalgia a medically recognizable illness and who say that diagnosing the condition actually worsens suffering by causing patients to obsess over aches that other people simply tolerate. Further, they warn that Lyrica’s side effects, which include severe weight gain, dizziness and edema, are very real, even if fibromyalgia is not.  Despite the controversy, the American College of Rheumatology, the Food and Drug Administration and insurers recognize fibromyalgia as a diagnosable disease. And drug companies are aggressively pursuing fibromyalgia treatments, seeing the potential for a major new market.  Dlabtot (talk) 00:35, 15 February 2008 (UTC)
 * I asked for your view as you're the one making a deal of it, that's all. But to the quote, yes it does use the term "controversy", the article also does. But please note that I didn't say that either didn't. I said that it wasn't used in a meaningful and substantial way. To me the use of the term in the NY Times article is hypberbolic, as newspapers tend to do, in the real world there is no actual 'controversy' to speak of, there is only disagreement amongst certain, relatively few doctors - please also note in the NYT the use of what on here would be weasel wording, e.g. "some doctors", "those doctors" with no quantification. As I said earlier, the vast majority recognise it, the vast majority of health organisations recognise it. That does not read controversy to me. That reads that a few doctors, for whatever reason (most likely self servance e.g. Sarno) don't want to recognise it. Controversy is defined as: 1. a prolonged public dispute, debate, or contention; disputation concerning a matter of opinion. 2. contention, strife, or argument. That is, there's a certain amount of 'heat to light' with regard to the debate. Neither the article nor the cite demonstrate that. I'm not saying everything is hunky-dory and there isn't any disagreement. I just don't believe it to be "controversial" per se. The medical world is not up in arms over it, GPs everywhere aren't refusing to treat for it etc etc, ie its use is pure hyperbole and it makes it sound more than it is, certainly more than the body of the article demonstrates. Disagreement is not necessarily controversy. -- Web H amster  01:27, 15 February 2008 (UTC)
 * I'm not persuaded that you have justified your revert. Your lengthy comment does a good job of explaining your own viewpoint, however, your viewpoint is just as irrelevant as mine. I have demonstrated that a controversy does exist and is documented in reliable sources.  However, I lack the energy to prolong the dispute beyond this simple appeal to reason and WP:V. Dlabtot (talk) 01:39, 15 February 2008 (UTC)
 * Your persuasion isn't required which is why I'm not attempting to. You asked why I reverted. I've explained why. The fact remains that it isn't a controversial disease. The disease exists, it's well documented and there is specific criteria as to what it consists of. Its existence is accepted by the majority of doctors and health organisations. Just because a few doctors don't believe the majority and just because a non-medically qualified journalist uses the term does not make the disease itself controversial. What is controversial is the fact that a few doctors disagree against all evidence. That makes the disagreement controversial, not the disease itself. -- Web H amster  02:14, 15 February 2008 (UTC)
 * Actually, contrary to your assertion that it is not required to justify your edits, Wikipedia operates by consensus, not by the arbitrary decisions of those editors most passionate about a subject. Dlabtot (talk) 03:01, 15 February 2008 (UTC)
 * There you go again, putting words into my mouth. I haven't asserted anything of the sort. I haven't justified anything, that was your description not mine. I've explained why I made the edit/revert. So far there is no consensus either way. There's you and there's me. The reason I haven't attempted to "persuade" you, is because there's no mileage in it. You've already made your mind up, which is why you are wasting both your time and mine with this little circular argument. Perhaps that this point we should get something sorted, I don't own this article, I've made very few edits to this article so your accusation of me breaching WP:OWN holds as much water as the rest of the arguments you've put forward. You keep banging on about the NYT using the C word. Well let's just have a closer look at how it's used shall we? My reading of the article is such that the controversy is about Lyrica, not about FMS, especially given that that is what the article's actually about. Whereas the reference to the C word in the last para of the article lead is also misleading as it refers to the article as if the article was about FMS, when it isn't, tt's about Lyrica. In fact the way the NYT article is written makes the subject of the "controversy" unclear. It doesn't specifically refer to anything, other than perhaps the preceding paragraph which contains material about FMS and Lyrica. So what exactly is the controversy Berenson is referring to? The disagreement amongst certain doctors about FMS or about the side effects of Lyrica? Not once either in that article or in this WP article (until the edit which I reverted) does it use the term "controversial disorder" or any variant of it. So to use it in that manner is basically WP:SYNTH. Yet another reason for it not to be used. You see you aren't the only one that can point at WP guidelines you know. Now it strikes me that your whole argument is based merely on the fact that the C word appears in the NYT article. So please point me at somewhere that uses the term I deleted, or failing that have a go at my previous suggestion vis-a-vis a controversy section. Surely if it's as controversial as you state then you should have no problem, additionally you'll be able to use the C word in it's previous incarnation in the first sentence. Perhaps when someone else comes along they can have a look at the reasoning you've put forward compared to mine. In the meantime I suggest you quit putting words in my mouth and wikilawyering with nonsense link waving. -- Web H amster  03:41, 15 February 2008 (UTC)

RfC: Is it appropriate to describe the diagnosis of Fibromyalgia as 'controversial' as per the NY Times?
A recent article in the New York Times outlined the controversy around the diagnosis of fibromyalgia. Is this verifiable citation to a reliable source sufficient basis for characterizing the diagnosis as controversial? Dlabtot (talk) 04:02, 15 February 2008 (UTC)

Responses by involved editors
See above section as I'm not typing it out all over again. -- Web H amster  21:28, 15 February 2008 (UTC)

WebHamster, please try to resist the urge to reply to the RfC respondents who disagree with you in the uninvolved editors sections. Simply because I believe it makes it easier to determine RfC consensus if you can clearly see who is saying what. Dlabtot (talk) 21:38, 15 February 2008 (UTC)
 * No chance, Not if they aren't making their involvement clear. In any case it wasn't a "reply" per se, it was an observation/comment/warning. Meanwhile please leave your advice/lecture in the appropriate place (please wash your hands afterwards), thank you. -- Web H amster  21:44, 15 February 2008 (UTC)

Responses by uninvolved editors
Please do not edit this section if you are a party to the dispute.

I think we should avoid the word "controversial" as far as possible. Most things are controversial and soon the word will lose meaning on wikipedia. See my comments on the Wikipedia_talk:Words_to_avoid talkpage at which I notice the proposer has now chimed in on. Mccready (talk) 09:20, 15 February 2008 (UTC)

This is an article about a medical topic. As in other medical articles, everything that has major inpact should come out of peer reviewed scientific/medical journals, not out of the mass media. If anything, the article is worth a side note, not more. —Preceding unsigned comment added by 192.68.211.173 (talk) 12:29, 15 February 2008 (UTC)

In the case of Fibromyalgia, I agree with Dlabtot that describing it as "controversial" is most appropriate, and that the article in the NY Times is a reliable source. This quote from that article illustrates the nature of the controversy: "Dr. Frederick Wolfe, the director of the National Databank for Rheumatic Diseases and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety." "“Some of us in those days thought that we had actually identified a disease, which this clearly is not,” Dr. Wolfe said. “To make people ill, to give them an illness, was the wrong thing.”" Ralphyde (talk) 18:52, 15 February 2008 (UTC)
 * Given your views on TMS and your support of Sarno you can hardly describe yourself as "uninvolved". It's in your beloved Sarno's interests to maintain a view of controversy, if only to sell the books and the 'private tuition'.-- Web H amster  21:27, 15 February 2008 (UTC)
 * Disclaimer, I am uninvolved in the article dispute, but I do edit the Chronic Fatigue Syndrome article which is a related illness. I do not believe that describing the illness as "controversial" based on the New York Times article is proper because of the context in the article,


 * "Despite the controversy, the American College of Rheumatology, the Food and Drug Administration and insurers recognize fibromyalgia as a diagnosable disease. And drug companies are aggressively pursuing fibromyalgia treatments, seeing the potential for a major new market."


 * First, it is the author of the article that describes the issue as "controversial" not a medical authority or organization. Tabloids love to make things "controversial" for the purpose of selling papers, so an authors use of the word "controversial" should not be given much weight.


 * Second, the quote states, "the American College of Rheumatology, the Food and Drug Administration and insurers recognize fibromyalgia as a diagnosable disease." That disputes the authors arguments of it being "controversial" and therefore not appropriate to describe the diagnosis of Fibromyalgia as 'controversial'. Ward20 (talk) 21:21, 15 February 2008 (UTC)


 * I am going to qualify my statement after reading Someguy1221's comments. Digging into the issue more, I realized I had a narrow view of the RfC. I was fixated on the recent edit that inserted "controversial" in the first sentence and concluded the RfC was only discussing "controversial" in this context and I did not address the broader issue. That was an error on my part. I agree with Someguy1221, the Times story's concerns are appropriate farther down in the article. The NY Times content is already included in NPOV wording at the end of the lead. My opinion is the present content gives it reasonable weight. Ward20 (talk) 20:08, 16 February 2008 (UTC)


 * While the New York Times might not be considered the most reliable source on medical information, it remains a reliable source on the notability of medical viewpoints. And so I wouldn't see any issue with briefly explaining the concerns expressed in the article within a low down section in our article. But short of a wider display of the notability of this viewpoint, I think it would violate undue weight to have it leave such a section or, say, make it into the lead. Someguy1221 (talk) 08:47, 16 February 2008 (UTC)


 * A quick scan of recent news headlines that contain the word "fibromyalgia" indicates that there is still a good amount of skepticism/controversy regarding the diagnosis, whether or not this skepticism/controversy is justified. Here is just one example, chosen primarily because it made me laugh:


 * (From http://www.philadelphiaweekly.com/articles/16388)


 * Do you know any lawyers willing to take on a personal-injury suit concerning fisting-induced fibromyalgia? When I call local personal-injury lawyers here in Eugene, Ore., they get all flustered. Fisting Fallout


 * “It is a little controversial whether fibromyalgia is a real disease at all or just a mysterious constellation of symptoms,” says Dr. Barak Gaster, Savage Love’s long-suffering resident medical expert. “Most mainstream doctors accept it as real, but it’s still in the slightly dubious category.”


 * Now, it doesn't matter that this Dr. Gaster is probably woefully uninformed. What matters is that this is a fairly common attitude, even among medical professionals.  It doesn't make one bit of difference that they're wrong, and that fibromyaglia is real, etc.  The bottom line is that there should be a section dealing with the skepticism/controversy surrounding fibromyaliga.  Acknowledging that there are dissenters from the mainstream view does not "lend legitimacy" to their point of view, which I suspect is the real reason for opposing any mention of the minority view.  Mention it, provide ample references, and show that these people are idiots &mdash; don't pretend that there is no controversy!  --Sapphic (talk) 00:08, 26 February 2008 (UTC)


 * Good point, since the lead discusses it and should reflect the article content, there should be a section about it (hopefully not with that reference). 8 P Ward20 (talk) 00:50, 26 February 2008 (UTC)

Another one of many, I would have to this is about as reliable as you can get. The "illness" which is a ragbag collection of symptoms that varies from person to person and is categorized as Fibromyalgia. Depression of fluctuating severity is quoted as the only consistent symptom. The next most common is IBS so when combined muscle pain / fatigue and other symptoms, a diagnosis of Fibromyalgia is given. But to characterize the diagnosis as controversial is harsh, its like the symptoms of the flu they can vary enormously between individuals. Omeganumber (talk) 21:20, 3 March 2008 (UTC)


 * Well no; this would be more like some doctors claiming the influenza virus is entirely made up. For that is essentially the view presented of FM in the NYtimes article, that there is no physical cause of the symptoms. Someguy1221 (talk) 23:19, 3 March 2008 (UTC)


 * FM is a commonly-understood example of a "gray area" type of disease in which there's enough confusion and doubt within the medical field concerning its etiology and treatment that a noteworthy minority is still skeptical of the diagnosis. (The acceptance seems to be growing, too. ADHD seems similar in this regard.) I think that "controversial" may be technically correct, though it perhaps reads as overly-harsh. It's certainly citable (see below). I find it odd that the article doesn't discuss this reality at all; to this end, I agree with WebHamster's statement (section above) that the lead should represent the rest of the article. The clear solution here is that the article needs to have a section discussing the existence of FM as not-completely-accepted by relevant professionals and organizations, presently and historically. Then the lead (which is not worded well) will match what the article text should offer.
 * &mdash; Scientizzle 00:11, 8 March 2008 (UTC)
 * &mdash; Scientizzle 00:11, 8 March 2008 (UTC)
 * &mdash; Scientizzle 00:11, 8 March 2008 (UTC)
 * &mdash; Scientizzle 00:11, 8 March 2008 (UTC)
 * &mdash; Scientizzle 00:11, 8 March 2008 (UTC)
 * &mdash; Scientizzle 00:11, 8 March 2008 (UTC)

Alex Berenson's article in the New York Times was a very poorly researched piece that was consumed without too much critique because it is de rigeur to demonize drug companies at the moment. When it comes to discussing to appropriateness of citing that essay, I can't do much better than to quote what I sent the Editor: ("Drug Approved: Is Disease Real?") has helped propel the cause of FMS patients back 25 years. It's not difficult to interview several parties and string together anecdotal "evidence" in an inflammatory puff piece. Had Alex actually done any research on the disorder, he would know that Wolf was not the first to characterize the syndrome (that was done in 1987, the year I was diagnosed), and that there are objective findings in research studies that distinguish FMS patients from others. This is seen at the cellular level (mitochondrial abnormalities) as well as in the aggregate (orders of magnitude more pain-related neurohormones in cerebral spinal fluid). The current state of the science indicates that this is a CNS disorder. While the etiology is unclear, there are some very well defined theories about abnormalities of the HPA axis which result in a cascade effect, disrupting a wide variety of hormones (a potential explanation for the prevalence in women, as opposed to mysogynist musings about "20th century hysteria"). There are demonstrable differences in levels of human growth hormone, in sleep patterns, in coagulation, and on and on. In your paper's rush to print a sensational piece regarding new uses for existing drugs, you have done a terrible disservice to those of us who have spent decades dealing with doctors with the same biases as the author. The market for these drugs has existed for quite a while now, but this has been an "orphan" condition, lacking research focus, precisely because of the biases exemplified by this article. Alex might try looking at the treatment methodology (heuristic) developed by the Fibromyalgia & Fatigue Centers, Inc, founded by one of the male sufferers of the syndrome, who was shocked to learn how the primarily female patients have been treated, and recognized the market opportunity. FFC's Medical Director is Jacob Teitelbaum M.D., and the head of their Medical Advisory Board is Kent Holtorf, M.D.. The apparent financial success of this ever-growing chain of clinics was, I suspect, the first indication that there is a lot of money to be made addressing this disorder; any analyst following the sector could have seen this. And it would have been so simple for Alex, or a fact-checker (do you have those?) to do a little research on this site: http://www.fmnetnews.com/index.php. I no longer have access to Medline to research scholarly articles, but I know there are research studies available that would have enriched the discussion of this affliction, if a "fair and balanced" approach was the goal. Frankly, I don't care how craven the drug companies may be. Cymbalta and Lyrica have helped me, and - after 25 years of being told this is "all in your head," actual help is a relief. But I wonder what impact a front page article like this will have on potential research dollars, the very resource that could insure that we get safe and effective treatment in the future. This article is a grave disservice to the many women and men who experience very real, constant, unremitting pain.


 * Guys, I won't attempt to duplicate the available synopses of current research, nor will I go head to head with the MDs and PhDs among you. I understand the condition is "controversial" and why.  But to cite as "why" this crappy article in the NYT (a paper which I happen to love) if very unfair.  Wikipedia should live up to its own oft-demonstrated standard for intellectual rigor, and not let that perverse piece of journalism self-replicate.  Stop it now.  Controvery = legitimate scientific conflict about as-yet inadequate hypotheses, a la Thomas Kuhn.  Simply because a comprehensive all-predictive theory has yet to be agreed to, doesn't mean a disease-state does not exist.  The practice of medicine is very different from its research; they are miles apart. There are not millions of women, some of them quite hardworking, who have suddenly conspired to report the same symptoms, or, more laughably, the same OBJECTIVE FINDINGS (e.g. clotting disorders).  The controversy is in the EXPLANATION, not in the EXISTENCE, unless you are truly a heartless medical professional.Andraste60 (talk) 06:05, 27 March 2008 (UTC)andraste60

-I forgot my original password so have to wait forever for confirmation. What is controversial is the way one is diagnosed by a rheumatologist. One only sees what one knows! Pain/tenderpoints YES viking gene, sign. MS NO Auto immune or other ana factors NO Longer then six months YES Usio conclusio it must be fibromyalgia.

There is no cure. (why get a reactive depression, here's your answer. You are responsible for dealing with strain (difference between the load and your capacity to deal with it.) One is prescribed amytriptiline in a low dosage, since, in the original drugstest they stumbled upon the fact that it SOMETIMES helps people that suffer from neuralgia. It made me very ill. And fat. I have suffered 18 years with IBS coinciding with backpain. I've even spend time in hospital more dead then alive, but they could find no cause. I've even been paralysed from the neck down and recovered. I have times were i go blind for an hour in one eye. I have scoliosis, spondolytis and kyfosis, bursitis and ordinairy arthrosis. Recurring backtrouble. I've talked my ass off to psychologists. Nothing takes the pain away since endorfines are not made? It's a neuro-endocrine disease where nociceptors are involved. The soma indeed. But a psychologist is cheaper then actually diagnosing one properly. I hope an aio is present since i am going to be the first fibromyalgia sufferer, without reactive depression (read the canadian study of 1992; incidence and predisposition same as in the normal population, though when depressed it's more often reactive depression)if one still feels one has a choice such depressions can be avoided)but with calcifications in the brain. Now i'm starting to suffer cognitive and neurological problems and can't be bothered with the group that claims to have the answers, "since they cured their own backpain"!!!. Most backpains will go away within twelve weeks anyway. GABA based medication, just like Lithium and a lot of other wonderdrugs for depression, causes even more damage to myeline shafts.(research on rats with EAE). The new quack is giving FM sufferers pills without really having them diagnosed properly! We are a heterogenous group.But do have certain characteristics like bodybuild in common(canadian study again...bang on the nose) I've been extremely active all my life. Burning the candle at both ends frankly. And have been in mourning for all the things i can not do anymore. How did i notice something (now what) was wrong? I walked 15 meters and had the feeling i had just finished a marathon. Must be a virus i thought. But it did not improve! The mind is very willing but the body reacts differently. Wrong! Push it, put it on clockwork and it gives out entirely. I allmost drowned from exhaustion and cramps in the swimmingpool after a few laps. Me...amongst other things a lifequard and certified fitness instructor! I consider my condition an effect of trying to compensate for untreated disorders and complaints. And now getting my come-uppance for thinking everybody else lazy. With the body not working i can cope but not with the brain starting to fail! WAIS III testing should also be part of diagnosis for f.i. braintrauma or to conclude that we get alike symptoms for free with the condition! (significant difference in verbal capacity compared to working memory might signify mild to serious brain injury) I am gratefull for some people here that at least try to maintain a scientific discussion. Especially the contribution on HGH, low IGF, low cortisol, high levels of neuropeptic Y and someone mentioned somewhere factor P in the blood /serum/spinal fluid? But like others with the condition, it get's too close to home to stay neutral. The original of this article stated that people had no other underlying disease or condition. Frankly next to a reumathologist one should also see a bonedoctor and a braindocter! Have MRI's made etc. So sorry for not offering sources. Though i notice that english is easier then my own language that i type dyslexic. Strange... ... remember that 60 years ago there was no treatment for hypertension and heartdisease related to it. Now however there are still a few forms of hypertension that they have no remedy for. One could also call that psychosomatic or idiopathic. Or lack of funding/intrest etc.

Cognitive therapy only works if one has cognitions to work with. idiopathic and no cure do not fill the bill.

Oneworld again:i want it to be anything but fm Together with the mri flair result, the site medpix and my medical history i found this as a temporary conclusion on wiki: quote: Unfortunately, the prognosis for significant recovery from acute transverse myelitis is poor in approximately 80% of the cases; that is, significant long-term disabilities will remain. Approximately 5% of these patients will, in later months or years, show lesions in other parts of the central nervous system, indicating, in retrospect, that this was a first attack of multiple sclerosis.[citation needed]

Bring on the steroids and let's have it over with! Though MS in my case will probably also be labeled idiopathic(no factors, no gene, no auto-immune) and maybe no permanent cure. But fibromyalgia and IBS could just be the intermittent stage!In case you're wondering:The reaction of the neurologist (friend of my ex, who was by the way a psychologist)  on being lame from the neck down, half suffocating and recovering: "this is normal after heavy excertion, the nerves stop transmitting messages i.e. the muscles do not pick them up." Nerves getting stuck(incredibly painfull, cold sweat, nausea)in my back "was a normal feat in women."

I had seen one woman in a store that showed the same symptoms and since it happened ever so oft and since i knew how to unstuck the damn thing, i took it to be normal. Now i've learned how to avoid it getting stuck at all. And that all these events are not normal! It's like people are lying to me for about 18 years.

As a child i was stung by about 2000 bees. It landed me in a coma. Apatamine(hope i state the name of one of the poisons correctly)and another substance of life bees is used to mediate the suffering of MS patients. I strongly feel they should calculate the doses and reproduce it chemically, instead of killing bees(since i allready killed a lot and they are dying anyway from a weird virus.And we need them!) Maybe i acquired the possibility of attracting MS because of that overdose?

My neurologist and the lab still have a lot of work to do. It's easier to factor out fibromyalgia. Or can MS en FM coincide?

regards.oneworld —Preceding unsigned comment added by 84.105.38.53 (talk) 02:00, 8 October 2008 (UTC)

deleting link to Fibromyalia web site issues
My adding of an external linked to a web site was removed.

I am carer for my wife Mary who has suffered from Fibromyalgia for over 10 years full diagnosed. We also run a small support group for sufferers and their carers here in Rugby UK and are active web surfers.

Whilst I appreciate Wiki is not a repository of web links, I do feel the removed web link does have some merit based on our experiences and would if readded would provide a useful link for vistors to the subject page.


 * 1) Fibromyalgia is a major illness hitting mainly women (but not exclusively)


 * 1) Figures suggest 1-3% of the population suffer from it, and certainly detection and formal diagnosis is increasing, as well as YOUNGER people being diagnosed with it.


 * 1) despite some claims, there is no specific cure but some sufferers have been "cured" by different methods, but what may work for 1 does not work for 99 other sufferers so the problem and the solution is ongoing.


 * 1) people want RELIABLE information and sources of other places for MORE information specific to their needs.


 * 1) Many support groups have been set up around the world, and knowing where they are is a useful service, the site is one of a FEW which provides a directory of support groups which can be freely added. It also gives advise about setting up and promoting a local group which is useful.


 * 1) sufferers also want to know they are NOT ALONE and have the opportunity of meeting other sufferers to discuss problems (online or via local groups) and swap ideas and information. The site does that via a discussion board.


 * 1) there is naturally a large volume of personal web sites with limited and often confusing information about Fibromyalgia, but based on a review of the discussion board and content the site seems well designed with a large volume of reliable content and links to external sources, leading me to believe it is good PORTAL for sufferers from Fibromyalgia and their carers as well as professionals supporting sufferers.

It would be inappropriate and irresponsible of me to attempt to re-submit the web site again and will leave it to others to debate (if appropriate) the merits and submit the site again or others which they feel more appropriate to the cause.

The site is www.fibromyalgia-support.net

(websi7) 05.42, 30 March 2008 (UTC)
 * While I am not one who has deleted links placed on this article I have on one or two others. You need to establish that your site has unique content apart from others to be able to stand on its own.  Does it? Mikebar (talk) 14:05, 30 March 2008 (UTC)


 * WP's policy is to exclude links to sites just like yours (eg support fora), but even if it this policy were not in place, your site is hardly worth linking (less than 200 posts on forum, Google ad farm, every instance of the word fibromyalgia bolded to trick search engines). It looks just like one of those sites some people set up in droves to get Google Adsense money. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 20:20, 30 March 2008 (UTC)
 * Checking your contributions, I see you are a spammer who has been systematically adding your websites to many pages, some of which have been reverted already, and I have reverted the rest. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 20:31, 30 March 2008 (UTC)

New External link to http://www.fmauk.org
As per the instructions on the links page a request for a link was to be posted on the talk page. I believe that the Fibromyalgia Association in the UK should be listed as a link as it provides essential information on the condition, living with it, dealing with benefits and employment situations etc. The site also hosts a large and popular forum that helps suffers.

Some information about the charity: "Fibromyalgia Association UK is a registered charity administered by unpaid volunteers from the Chair down through the ranks. The majority of volunteers are also fibromyalgia sufferers who work extremely hard, despite their condition, in order to forward the cause of fibromyalgia. FMA UK was established in order to provide information and advice to sufferers and their families. In addition, the Association provides medical information for professionals and operates a national helpline." —Preceding unsigned comment added by Desquinn (talk • contribs) 21:50, 10 April 2008 (UTC)

Controversy Relocated
Given that fibromyalgia continues to be plagued by 'controversy' regarding the validity of the diagnosis as a clinical entity, I will concede that a "Controversy" section is topical and germaine. However, there are several other diagnostic entities that are surrounded by controversy that have similar headings in their articles figured much less prominantly than the one featured here (or, at least, prior to my changing its location). Take schizophrenia, for example: there are those in the medical field that would advocate elmininating it entirely from the Diagnostic and Statistical Manual (DSM); however, a check of the wiki article on schizophrenia demonstrates that this matter is addressed well after a discussion of material pertinent to an understanding of the disorder per se. There is an abundance of objective evidence distinguishing the fibromyalgia patient from those of us not afflicted by the disorder. While there exist an element of society who choose to turn a blind eye to these data, it is helpful to bear in mind that Parkinson's disease was once considered a form of 'madness' and asthma -- even very recently -- a manifestation of 'hysteria' (whatever that is...).

Dr. Anymouse (talk) 12:20, 15 April 2008 (UTC)

As a disinterested outsider, I feel compelled to point out that this article feels a lot more like a "Fibromyalgia is real" advocacy site than an encyclopedia entry.

I would suggest that some notion of the controversy surrounding this syndrome is mentioned in the introductory paragraph, and not relegated to a weasel-worded controversy section.

The reality is that the people who believe they have this syndrome are going to be a lot more passionate than those who don't, but you really should not let that dictate the tone of the article: it's supposed to be neutral.

This is really the first Wikipedia article I've come across that made me feel like I couldn't trust the article and had to look elsewhere for information.

Davepl —Preceding unsigned comment added by 207.115.84.2 (talk) 20:39, 2 May 2008 (UTC)

I'm not sure where this should go, but the imaging study "Clinical Correlate of Brain SPECT Perfusion Abnormalities in Fibromyalgia" by Eric Guedj, Serge Cammilleri, Jean Niboyet, Patricia Dupont, Eric Vidal, Jean-Pierre Dropinski, and Olivier Mundler in J Nucl Med, Volume 49, Number 11 • November 2008, pp. 1798-1804, seems pretty relevant to either controversy over existence of syndrome, or to the pathology. Could one of our fine wikipedians get this reference into the appropriate location? —Preceding unsigned comment added by 75.164.190.93 (talk) 21:23, 3 November 2008 (UTC)

Fallacy
As a medical student about to graduate and attending one of the best london medical schools i feel it is my medical duty to inform others that we are taught that no such disease exists. Why is this not made clearer in the article? To the average reader it would appear this is an organic 'real' disease. posted by 83.104.130.77
 * For a student, it is essential to learn not to take everything that people say for granted. On average, about half of what is taught is false. It is your task to you to find out which half. Regards, Guido den Broeder (talk) 10:34, 19 April 2008 (UTC)
 * Now, if you think the article needs improvement, go ahead and edit it. Be aware though that this is an encyclopedia, so what is said must be neutral and based on reliable sources. If it is otherwise, it is likely that someone else will change it back. Guido den Broeder (talk) 10:45, 19 April 2008 (UTC)


 * It's not made clear because there are a large number of editors who immediately remove any such material from the article. Which makes this article a good illustration of why Wikipedia itself can not be considered a reliable source.  Articles tend to attract editors most passionate about the subject, in this case, a large number of people who believe they are suffering from from this, and consider any questioning of the reality of the diagnosis to be a personal affront. Dlabtot (talk) 20:19, 19 April 2008 (UTC)
 * If it is that clear that it's a fallacy, it should be easy to find reliable sources that confirm that no such disease exists. We need reliable sources for every piece of information, so that the information is verifiable by others. A  ecis Brievenbus 22:53, 19 April 2008 (UTC)


 * Two words, my young friend: Question Authority. As a larval physician, you have the opportunity to participate in history and make a difference in the lives of the thousands of individuals.  Read the literature for yourself!  Come to your own conclusions!  ...or consign yourself to being an embarrassment to the profession as will be the case for all those who protest the "reality" of this entity.  Do you know the names of those who dismissed Parkinson's disease as madness?  Who was it that preached asthma was mere histeria?  Or have they stopped teaching those things in your Medical School?  Dr. Anymouse (talk) 14:41, 22 April 2008 (UTC)

Those who would not question themselves have no business questioning authority. Davepl —Preceding unsigned comment added by 207.115.84.2 (talk) 20:41, 2 May 2008 (UTC)

Controversy??
While I understand that there is controversy, I do not understand WHY. Fibromyalgia is a real disease, and it is quite clear to those suffering from it and those who interact with them or even see them every so often that it is more than a hypochondriac tale.MegaZega93 (talk) 00:02, 9 May 2008 (UTC)


 * Fibromyalgia makes absolutely no suggestion that fibromyalgia is believed (by any reliable authorities) to be a manifestation of hypochondria (with the possible exception for a small minority of sufferers). You may want to read that section over again, and then read its references if the nature of the controversy is still unclear to you. Someguy1221 (talk) 00:56, 9 May 2008 (UTC)

hGH, vitamin D3 and Fibromyalgia
I posted the following and it was removed as being irrelevant to fibromyalgia.

''Research showing that human Growth Hormone is inhibited by 1,25(OH)2D3 ( a vitamin D3 metabolite )[27]lends some support to the view that the low levels of hGH in fibromyalgia patients may be associated with bacterium which interfere with the Vitamin D Receptor. Blockage of the Vitamin D receptor can lead to low levels of 25 D3 and overtranscribed levels of 1,25(OH)2D3. Since 25 D3 is the form typically tested for clinically, the condition can easily be misread as 'Vitamin D Deficiency.'''

I'd like to make the case for its relevance here, though it isn't my theory. Trevor Marshall is one of the more vociferous proponents. His theory is that many autoimmune diseases are the result of pathogens which alter the body's immune system in order to maintain longterm chronic infections and keep themselves from being cleared. He uses capenine as a model example of what he's referring to. Capenine is a sufonolipid produced by some bacteria which blocks the Vitamin D receptor. The result of Vitamin D receptor blockage is that 1,25 D3 doesn't downregulate its own production and is produced in large quantities. So bacterial blockage of the vitamin D receptor causes problems both in terms of disabling an important element of the human immune system as well as overproduction of 1,25 D3 which apparently inhibits production of human growth hormone.

This is significant since many problems related to fibromyalgia can be treated through administration of hGH. People with fibromyalgia have trouble entering deep sleep and producing hGH. The study I cited provides a mechanism by which bacterial infection would downregulate production of hGH. --Ryan Wise (talk) 23:06, 1 June 2008 (UTC)


 * Policy is pretty clear. Unless there is a reliable source that makes the connection between this research and fibromyalgia, it's pure original synthesis, and has no place in this article. Someguy1221 (talk) 00:29, 2 June 2008 (UTC)


 * Your notes on the edits claimed that you read the article, but you deleted text that was supported by the citations. Please read the information again and alter only those portions that you believe are not supported by the citations. --Ryan Wise (talk) 03:12, 2 June 2008 (UTC)


 * Yes, I read the article, and it never once mentions fibromyalgia. As such, any content that is supported by the citation is necessarily irrelevant to this article, and the accuracy of the citation has no bearing on whether the content should be kept, which it should not. I'm going to emplore you one more time to actually read original synthesis; any claim that cannot be supported by a reliable source should never appear on Wikipedia, and in this case it is the first sentence of your quoted content above. The second sentence is, as I've explained, irrelevant. Someguy1221 (talk) 03:43, 2 June 2008 (UTC)

working large muscle gorups like the thighs releases HGH hormones
just that I would let the editors know. As I suffer from depression and I use a limited but focused exercise regime for combating stress. —Preceding unsigned comment added by 98.242.74.217 (talk) 02:33, 11 June 2008 (UTC)

Timeline
Good info but no references and it was signed within the article by User:Tarantula17 so it can be construed as original research, something not allowed under current rules. I'd like to see the section stay but it'd need cleanup. Mikebar (talk) 09:32, 14 June 2008 (UTC) Actually it's the first thing I've contributed to Wikipedia; and I'm having a bit of brain fog when I edit it. Could someone point me out the way to do references again? I have three for the Timeline. Thanks! —Preceding unsigned comment added by Tarantula17 (talk • contribs) 07:29, 15 June 2008 (UTC)
 * See Citation templates for methods of documenting your edits and thanks for your contribitions! Mikebar (talk) 06:54, 1 July 2008 (UTC)

Healing Fibromyalgia
Exerpt from Myofascia Pain Syndrom (MPS): MPS may be related to a closer-studied complex condition known as Fibromyalgia. Wolfgang 93.128.75.222 (talk) 18:23, 19 June 2008 (UTC)

Big Thanks
I just wanted to put up a general THANK YOU to all of you who've chipped in to make this a very viable article in total on FMS. Having worked with the condition personally and semi-professionally for 15 years, I can see the wealth of information that has been put up, checked, verified and generally kept as accurate as possible. With so many places online that provide errant info to those who've just been diagnosed, it's great to know I can put up the Wiki link in our own charity website which those living in N. Ireland UK will know well, and know that they will get a quick synopsis on the condition. (And I have no objection to this comment being removed when required either as I appreciate it's not relevant perhaps, but did want to provide it). :) FMSNI. TikkiRo (talk) 15:18, 23 June 2008 (UTC)

Smart Diary Suite 4 as an external link
Hello,

I have been deleloping software to assist those with fibromyalgia in tracking their symptoms since 2003 - would it be ok if I add a link to my site to the article's "External links" section? The software is Smart Diary Suite 4 - it's located here: http://www.sdiary.com

Thanks, Dennis Volodomd (talk) 05:42, 2 August 2008 (UTC)


 * No. It doesn't qualify as a V & RS. -- <b style="color:#004000;">Fyslee</b> / <b style="color:#990099; font-size:x-small;">talk</b> 17:43, 9 November 2008 (UTC)

Review of treatments
JFW | T@lk  20:21, 18 August 2008 (UTC)