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Fibromyalgia was a good article, but it was removed from the list as it no longer met the good article criteria at the time. There are suggestions below for improving the article. If you can improve it, please do; it may then be renominated. Review: No date specified. To provide a date use: {{DelistedGA|insert date in any format here}}.

Talk Page Re-Structuring - PLEASE HELP by moving your own discussion points to appropriate categories.

• Assertion: As the associated talk page has become cluttered and random, a revision is due.
• Goal: the associated talk page should aid in directing useful discussion whose intent is the improvement of the encyclopedic contect of the associated main page.
• Proposal:
  • the associated talk page structure should, wherever applicable, follow the structure of the Main page.
  • changes to the structure of the main page, shall be discussed on the talk page under a heading of that title
  • a specific section dedicated to Critics &/or Skepticism should be part of the main page, but should not be the primary focus of the article
  • all discussion, testimony, personal statements, etc. not specifically related to improving the encyclopedic content of the the main page do not belong in Misplaced Pages and should be taken to Usenet or discussion boards.

Iggynelix 20:18, 13 March 2007 (UTC)

Archives

/Archive 1

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. 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 Misplaced Pages 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 Misplaced Pages, Bravo! 71.255.146.20 (talk) —Preceding comment was added at 07:44, 30 November 2007 (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 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 Misplaced Pages 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 15:16, 19 August 2007 (UTC)

References

Is anyone else concerned that there is no bibliography for this article?

External Links

I would like to have http://fibromyalgia.ning.com/ considered for the list of external links. It's a great community that focuses on this topic and seems to me like a valuable resource for people coming to the Fibromyalgia page in Misplaced Pages looking for information. manny (talk) 15:20, 25 December 2007 (UTC) ---

Is there a reason why the link to the documentary film, Living With Fibromyalgia, was removed? I found it through this article a while back and found it to be a great resource that was very balanced about this condition while still hopeful. As far as I can tell, it's the only feature-length, recent documentary that features the stories of real patients with the condition as well as doctors. I know when it was done it was with the blessing of the National Fibromyalgia Association. I just told a new patient to look for this link on this article and saw that it was gone now. I'm very new to this, so please excuse me if I'm not sure how this should work. I'd like to add this as an external link if it won't be removed again.Wikieditorba15 00:23, 4 December 2007 (UTC)

I agree with Wikieditorba15 in looking for resources for my mother-in-law I found the documentary film, Living With Fibromyalgia to be a nice introduction to the topic for the family.--Geakerson (talk) 19:42, 3 January 2008 (UTC)

You can't really add a link to a whole movie. Does it have its own wikipage? You could link to that in the body or see also section. WLU (talk) 19:47, 3 January 2008 (UTC)

---

Any reason not to link to the New York Times article from January 2008, boldly titled "Drug Approved. Is Disease Real?" Seasicksarah (talk) 22:48, 14 January 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 Misplaced Pages. 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)

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)

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 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 Misplaced Pages, 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)

Skepticism

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.

"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 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 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 W: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 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:

"Fibromyalgia Network". 2007. Retrieved 2007-10-18.

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 Misplaced Pages. 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#BLOG (also whilst I agree Misplaced Pages:Please do not bite the newcomers, also Misplaced Pages:Assume good faith is required). David Ruben 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 Misplaced Pages is not a directory or listing service (can always Google for support groups). David Ruben 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)

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 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 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 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 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 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 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 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 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 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. Antelan 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 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 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. Antelan 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. Antelan 01:02, 9 January 2008 (UTC)

OK, thanks. Guido den Broeder (talk) 01:07, 9 January 2008 (UTC)

Fibromyalgia Intro RFC

Template:RFCsci

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. Antelan 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? Antelan 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 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. Antelan 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 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. OrangeMarlin 02:46, 7 January 2008 (UTC)

Thanks for the comments guys. I have implemented the suggestions from above. Djma12 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 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. Antelan 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. Antelan 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 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. Antelan 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 Misplaced Pages 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? Antelan 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. Antelan 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.

Antelan 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. Antelan 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. Antelan 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 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 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 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 15:09, 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.

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)

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,...
3. which is assumed to be associated with better identification of the disorder.

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 04:20, 8 January 2008 (UTC)

The American College of Rheumatology says fibromyalgia affects 2-4% of the population. Antelan 04:26, 8 January 2008 (UTC)

Thanks, I'll put this citation in. Djma12 04:30, 8 January 2008 (UTC)

Looks like someone already did that, mea culpa. Does any have sources for the other statements? Djma12 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)

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)

1. Sarno JE; et al. (2006). The Divided Mind: The Epidemic of Mindbody Disorders. pp. 21–22, 235–237, 264–265, 294–298, 315, 319–320, 363. ISBN 0-06-085178-3. {{cite book}}: Explicit use of et al. in: |author= (help)
2. Leonard-Segal A (2006). The Divided Mind: The Epidemic of Mindbody Disorders. pp. 264–265. ISBN 0-06-085178-3. I have successfully treated many patients who carry the diagnosis of fibromyalgia. … It is almost as though those with fibromyalgia have so many issues from which the pain distracts them, that they accumulate pain in many locations as their defense mechanism. … 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.

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