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Revision as of 22:38, 6 April 2016

Ideal sources for Misplaced Pages's health content are defined in the guideline Misplaced Pages:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Fibromyalgia. PubMed provides review articles from the past five years (limit to free review articles) The TRIP database provides clinical publications about evidence-based medicine. Other potential sources include: Centre for Reviews and Dissemination and CDC

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This article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Misplaced Pages talk:WikiProject Medicine.MedicineWikipedia:WikiProject MedicineTemplate:WikiProject Medicinemedicine B This article has been rated as B-class on Misplaced Pages's content assessment scale. High This article has been rated as High-importance on the project's importance scale.

	Fibromyalgia was one of the Natural sciences good articles, but it has been removed from the list. There are suggestions below for improving the article to meet the good article criteria. Once these issues have been addressed, the article can be renominated. Editors may also seek a reassessment of the decision if they believe there was a mistake.
Article milestones Date Process Result December 12, 2005 Good article nominee Listed March 25, 2006 Good article reassessment Delisted
Current status: Delisted good article

Archives

1, 2, 3, 4, 5

This page has archives. Sections older than 100 days may be automatically archived by Lowercase sigmabot III when more than 4 sections are present.

This page is not a forum for general discussion about Fibromyalgia. Any such comments may be removed or refactored. Please limit discussion to improvement of this article. You may wish to ask factual questions about Fibromyalgia at the Reference desk.

Diagnosis

Could someone please add the 6 Fibromyalgia Rapid Screening Tool (FiRST) questions?

ICD codes, infobox vs. main text

About this edit, I do not strictly disagree with the edit summary. I just disagree with deleting from the infobox.

"ICD-9-CM 729.1", implies to be that 729.1 is the code for fibromyalgia. And that this code is included in the infobox. It just isn't just for it. The newer code is. I see no harm in including the official name for the code with it. It might not be the rule of WP for these infoboxees, I don't know. What's the harm? comp.arch (talk) 16:50, 26 July 2015 (UTC)

If you are attached to it I guess we can return it. IMO the infobox should be kept shorter. Doc James (talk · contribs · email) 14:25, 28 July 2015 (UTC)

SSRI Treatment

2015 Cochrane review found that the current evidence does not yet support SSRIs for fibromyalgia, this contradicts the 2009 JAMA meta-analysis and the usefulness of the FDA approved drugs in everything except that SSRIs help fibromyalgia patients with depression.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011735/abstract

How can the two sources be reconciled?

amosabo 13:40, 10 February 2016 (UTC)

Generally when that happens we just present both sources. --sciencewatcher (talk) 16:16, 10 February 2016 (UTC)

IF the Cochrane review takes further evidence into account (and it may have - six years is a long time) then we go with the most recent review - conclusions do change as more evidence is gathered. If the 2015 review is looking at the same evidence base as the 2009 review but comes to different conclusions, then we do simply juxtapose them and state their contradictory results. . Jytdog (talk) 17:32, 10 February 2016 (UTC)

I have gone back to the JAMA meta-analysis:

We found large effect sizes of TCAs for reducing pain, fatigue, and sleep disturbances; small effect sizes of SSRIs for reducing pain; small effect sizes of SNRIs for reducing pain, sleep disturbances, and depressed mood; and small effect sizes of MAOIs for reducing pain.

The Cochrane review is on SSRIs only and contains an extra 2010 study but otherwise contains the same studies bar one. Their conclusion was:

There is no unbiased evidence that SSRIs are superior to placebo in treating the key symptoms of fibromyalgia, namely pain, fatigue and sleep problems. SSRIs might be considered for treating depression in people with fibromyalgia.

Should we just make the distinction between the types of antidepressants? amosabo 13:13, 11 February 2016 (UTC)

BRD on 5 April 2016

user:173.162.170.106 made a bold edit. This was reverted by user:Jytdog. I am now asking for a discussion here. Jytdog appears to think that 173.162.170.106 is using advocacy. What is the evidence for this? Milligansuncle (talk) 20:23, 5 April 2016 (UTC)

Hi Milligansuncle! Thank you for raising this issue. I have no particular interest in advocating for low-dose naltrexone. I also have no stake in any pharma companies making naltrexone, nor compounding pharmacies that specialize in low-dose formulations. I do, however, have an interest in advocating for the truth - and the truth is, low-dose naltrexone has been shown to provide therapeutic effect in fibromyalgia in preliminary clinical trials. These trials were summarized in a review paper (secondary source), which is what I was able to cite for my contribution to this page.

I'm not sure why I'm being accused of advocacy. I suspect it is some form of ad hominem attack from Jytdog (Jytdog, feel free to chime in). In my contribution, I am indeed advocating that people do more research into LDN for fibromyalgia, but I would also advocate that people with Celiac disease should avoid gluten. Does that somehow make me biased/impartial? 71.184.73.233 (talk) 23:07, 5 April 2016 (UTC)

Please discuss content, not contributors, on article Talk pages. I'll be happy to discuss the content once you remove that. Jytdog (talk) 23:09, 5 April 2016 (UTC)

I did respond to the post on my user talk page. You have not responded.71.184.73.233 (talk) 00:41, 6 April 2016 (UTC)

Your remarks above ""I'm not sure why I'm being accused of advocacy. I suspect it is some form of ad hominem attack from Jytdog (Jytdog, feel free to chime in)." are inappropriate on an article Talk page, as are MilligaUncle's. Article Talk pages are for discussing article content. User Talk pages and notice boards are for discussing user behavior. I'll just open a new section since this was one is trashed. Jytdog (talk) 01:55, 6 April 2016 (UTC)

LDN

There are a series of IP editors promoting LDN for fibromyalgia.

• first, per our article on low dose naltrexone the overall evidence on LDN is weak and there is a lot of hype around it, so in general we need to be cautious.
• In this dif, 173.162.170.106 added content misrepresenting the source, which "reviews" LDN focusing on two studies (one in 9 people, the other in 30) of LDN in fibromyalgia done by the authors of the review (so it fails WP:INDY, but whatever) and which concludes: "The totality of the basic and clinical research to date suggests that LDN is a promising treatment approach for chronic pain conditions thought to involve inflammatory processes.". The added content said "has been demonstrated to provide therapeutic relief" which is as I said an overstatement: "suggest....promising" is very different from "has been demonstrated to provide". The dif also includes a bunch of mechanism stuff which is WP:UNDUE in an article focused on the condition. We generally don't do this in any management section on any medical condition; it is something we do have a section for in articles about the interventions themselves.

I reverted that, IP 108.49.228.2 added it back, I reverted again, and 173.162.170.106 added it back yet again.

• Doc James then did a big series of edits (here) and this content ended up in the Management/Other section appropriately stated and WEIGHTed: "Preliminary clinical data have demonstrated that low-dose naltrexone (LDN) may provide symptomatic improvement in fibromyalgia." No discussion of mechanism.
• IP 108.49.228.2 then came back in this dif again added content bulking this up with mechanism content, which is UNDUE here. I reverted that and 173.162.170.106 showed up again and restored it, I reverted again per UNDUE and MillgansUncle appeared and restored it, another editor removed it and yet another IP showed up 71.184.73.233, and restored it. It is not clear if these IPs and MilligansUncle are all one human being or separate ones, so it is hard to understand what is going on here. But in terms of WP:MEDMOS and how we generally edit about interventions in articles about medical conditions, the additional content here about mechanism is UNDUE. The one line, sourced to the non-independent review, is sufficient WEIGHT for this. Jytdog (talk) 02:27, 6 April 2016 (UTC)

This is reasonable. I agree with your assessment. For the record, I'm the one who introduced the sentence in question. There was another mention of LDN on fibromyalgia from a while back, but it was removed as part of a consolidation effort by Doc James. I re-added this, as it was a short description of LDN's mechanism, but it has subsequently been removed by a couple of different people, so I see that the consensus is that this sentence is not necessary.

Your section on phrasing is highly subjective. Nothing in the original post was untrue, but I can see that you felt the wording was excessively strong, so rewording it was/is fine.

For the record, it is not a "series of IP editors"...all of the anon edits so far have been by me, from multiple devices. I choose to edit anonymously. I am simply glad to be able to contribute to the public resource that is Misplaced Pages. 71.184.73.233 (talk) 02:46, 6 April 2016 (UTC)

Thank you for clarifying that all the IP edits were by one person. I am glad the content is settled. Any experienced medical editor in Misplaced Pages will see as a distortion, a description as ""is demonstrated" of a source that says "suggests...may be promising". This is not "subjective" it is the heart of what we do here as we summarize sources; these kinds of distinctions are very, very important. Please be closer to the source going forward. Thanks. Jytdog (talk) 03:05, 6 April 2016 (UTC)

Gluten

this diff amps up content about the role of gluten in this condition in a way that is UNDUE based on what is known. Content guessing that undiagnosed reactions to gluten (itself a very fuzzy thing) in an article about a fuzzily defined condition is unhelpful. The addition in the management section is just unhelpful - there are zillions of things that the literature suggest could be tried if X is also present; people have co-morbidities all the time. Jytdog (talk) 19:17, 6 April 2016 (UTC)

In my text: Non-celiac gluten sensitivity or an unrecognized celiac disease may be an underlying cause of fibromyalgia, but further research is needed., "unrecognized celiac disease" is a resume of this text from this source (currently removed by Jytdog), published on Nature Reviews Gastroenterology & Hepatology (2014 / 2015 Impact Factor of 12.61):

A case series has shed light on the potential benefits of a GFD in patients with fibromyalgia.71...However, the limitations of these studies are that although coeliac disease was felt to be excluded on the basis of negative serology and absence of villous atrophy, the patients might have had the early stages of coeliac disease (and not NCGS), given that a substantial proportion were HLA-DQ2 and/or HLA-DQ8 positive and showed increased duodenal IEL. NOTE: IEL =intraepitelial linfocitosis or lymphocytic infiltration

This means that these patients most likely have celiac disease, instead of non-celiac gluten sensitivity, and this is not a minority point of view, it is based in current guidelines and current knowledge of celiac disease, as for example "ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition|title=European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease":

4.2. Evidence Statements 4.2.1. The histological features of the small-intestine enteropathy in CD have a variable severity. The spectrum of histological findings ranges from lymphocytic infiltration of the epithelium to villous atrophy. (...) HLA Testing for HLA-DQ2 and HLA-DQ8. HLA testing should be performed in patients with an uncertain diagnosis of CD, for example, in patients with negative CD-specific antibodies and mild infiltrative changes in proximal small intestinal biopsy specimens.

Also, my text "At least a subgroup of patients with fibromyalgia have non-celiac gluten sensitivity or subclinical celiac disease (without obvious symptoms)." is based on this other source, which remains on the actual version:

some authors suggest that at least a subgroup of patients with fibromyalgia could experience subclinical CD or non-coeliac gluten intolerance and describe the benefit of a gluten-free diet on FM symptoms (76-78). (Table I). It has also been hypothesised that noncoeliac gluten sensitivity may be an underlying cause of FM symptoms. Non-coeliac gluten sensitivity is increasingly recognised as a frequent condition with similar manifestations which overlap with those of FM, and the elimination of gluten from the diet of FM patients is recently becoming a potential dietary intervention for clinical improvement. Nevertheless, further research is needed to clarify the role of gluten sensitivity in FM (79).

To clarify, let's take a look to the definition of "subclinical CD" (subclinical celiac disease), from The Oslo definitions for coeliac disease and related terms Gut (Impact factor: 14.66) 2013 Jan;62(1):43-52. doi: 10.1136/gutjnl-2011-301346. Epub 2012 Feb 16.PMID 22345659

Subclinical CD Subclinical CD is below the threshold of clinical detection. The term subclinical has often been used to denote silent CD80e82 or patients with CD and extraintestinal symptoms (and no gastrointestinal symptoms).83 The term has also been used for patients with CD who have clinical or laboratory signs (iron deficiency anaemia, abnormalities in liver function tests, enamel defects, incidental endoscopic features, osteoporosis, etc) but no symptoms.84 As understanding of CD has advanced, new disease associations have been regularly found and populations tested for CD have changed in response. For this reason, what is ‘subclinical’ has changed over time. To provide a stable definition, we specified subclinical CD to be disease that is below the threshold of clinical detection without signs or symptoms sufficient to trigger CD testing in routine practice. (...) This review was based on PubMed literature searches and expert meetings. We aimed to define key concepts relevant to CD and related disorders. The character of the current paper implies that we did not pool any data or use any statistical tools. Instead, we assembled an international team of recognised experts in CD research, discussed definitions and tried to reach a consensus. This approach is similar to that of previous papers on definitions of CD.2e4 As opposed to previous studies,2e4 however, we did not limit ourselves to ‘CD only’ but defined a large number of concepts. In addition, we provide guidance to the scientific and clinical community as to which terms should be used and which should be abandoned. Overall, we evaluated more than 300 papers in detail and all authors participated in the discussion leading to consensus definitions. (...) Our research team was multidisciplinary and was composed of specialists from gastroenterology, pathology, paediatrics, neurology and dermatology.

Nevertheless, I agree to let the section non-celiac gluten sensitivity as it is now. However, there is no reason to delete the section Diet, which also includes more information and not only about GFD.

The same situation occurred on the ADHD page, in which Jytdog removed the information about gluten-free diet, and after a discussion on talk page, it was finally added by Doc James. I will edit agein fibromyalgia page and follow the same pattern as he used, mentioning the number of studies (in this case, there are three) supported by this reliable sources:

Best regards. --BallenaBlanca (talk) 22:38, 6 April 2016 (UTC)

References

1. ^ Aziz I, Hadjivassiliou M, Sanders DS (Sep 2015). "The spectrum of noncoeliac gluten sensitivity". Nat Rev Gastroenterol Hepatol (Review). 12 (9): 516–26. doi:10.1038/nrgastro.2015.107. PMID 26122473.
2. "European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease" (PDF). J Pediatr Gastroenterol Nutr (Practice Guideline). 54 (1): 136–60. Jan 2012. doi:10.1097/MPG.0b013e31821a23d0. PMID 22197856. {{cite journal}}: Unknown parameter |authors= ignored (help)
3. ^ Rossi A, Di Lollo AC, Guzzo MP, Giacomelli C, Atzeni F, Bazzichi L, Di Franco M (2015). "Fibromyalgia and nutrition: what news?". Clin Exp Rheumatol (Review). 33 (1 Suppl 88): S117-25. PMID 25786053.

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