Talk:Fibromyalgia/Archive 2

Talk page structure proposal

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 Wikipedia and should be taken to Usenet or discussion boards.

Iggynelix 20:18, 13 March 2007 (UTC)

Diagram request

Could we add a diagram showing the 18 tender points? Perhaps someone could take a neutral anatomical image and add the points using a graphical software. --Steven Fruitsmaak (Reply) 19:38, 22 October 2008 (UTC)

Psychological factors need to be under one heading

The stress and depression subjects are spread out quite a bit. -- Fyslee / talk 17:45, 9 November 2008 (UTC)

Stress and depression are distinct concepts. What's the rub? Dr. Anymouse (talk) 14:01, 25 November 2008 (UTC)

Contra non sequitur (or, "Stop dabbling in Dualism")

I have removed a paragraph from the introduction that contained two propositional statements:

1. "Fibromyalgia is a controversial diagnosis, with opponents arguing that it is a non-disease."

2. "The association of fibromyalgia with psychiatric illness has been one of the most studied and controversial issues in fibromyalgia research."

These two sentences are ''non sequitur'' because the proposition that fibromyalgia is historically associated with psychiatric illness is predicated on the spurious notion that psychiatric illness are "non-diseases". I suppose next thing we will have to contend with is the members of the Flat Earth Society telling us there is no such thing as Parkinson's disease, major depressive disorder or schizophrenia. Puh-lease...

BTW, while we're on the topic - will someone kindly provide a definition for "non-disease" (?)

Dr. Anymouse (talk) 06:08, 23 November 2008 (UTC)

No, it's not a 'non-sequitor', it is sourced material that you just don't want in the article. You're reasoning is spurious. Dlabtot (talk) 15:34, 23 November 2008 (UTC)

Actually, I think a well-referenced documentation of the historical controversy surrounding this disorder is a much needed and desirable addition to this piece if for no other reason that it makes the opponents of the veracity of the disorder look very silly. What I oppose is the insistence on the part of some crusaders, er...editors that this quickly-becoming-anachronistic perspective be in the lead of the article rather than in the appropriate section. I am also opposed to the short-hand excuse for scholarship that is embodied in reliance on the work of a self-promoting hack from the NYT versus a critical review of the work of contemporary critics like Norton and Ehrlich which appear in peer reviewed scientific journals. If we are all striving to improve the quality of Wikipedia, then by god let's get off our lazy posteriors and do it. Dr. Anymouse (talk) 16:41, 23 November 2008 (UTC)

Hey, lookee what I found! Maybe yall could digest some of these here peer-reviewed journal articles and come up with something coherent. Or not. I would, but since I am such an unrepentant partisan in this dialectic, I'm not gonna pitch the manure -- that yall's job, ay't?

1: Ehrlich GE. No justification for publication of study on subgrouping of fibromyalgia patients: comment on the article by Giesecke et al. Arthritis Rheum. 2004 Aug;50(8):2716; author reply 2716-7. PMID: 15334497

2: Ehrlich GE. Symptoms without pathology. Rheumatology (Oxford). 2004 Apr;43(4):535; author reply 535-6. PMID: 15024147

3: Hadler NM, Ehrlich GE. Fibromyalgia and the conundrum of disability determination. J Occup Environ Med. 2003 Oct;45(10):1030-3. PMID: 14534442

4: Ehrlich GE. Fibromyalgia: when it shouldn't be diagnosed. Clin Rheumatol. 2003 Sep;22(3):259; author reply 260. PMID: 14505226

5: Ehrlich GE. Pain is real; fibromyalgia isn't. J Rheumatol. 2003 Aug;30(8):1666-7. PMID: 12913918

6: Ehrlich GE. Fibromyalgia, a virtual disease. Clin Rheumatol. 2003 Feb;22(1):8-11. PMID: 12605310

7: Ehrlich GE. Fibromyalgia is not a diagnosis: comment on the editorial by Crofford and Clauw. Arthritis Rheum. 2003 Jan;48(1):276; author reply 277. PMID: 12528138

8: Ehrlich GE. How many angels could dance on the head of a pin? J Rheumatol. 2002 Oct;29(10):2240; author reply 2240-1. PMID: 12375343

9: Hadler NM, Greenhalgh S. Labeling woefulness: the social construction of fibromyalgia. Spine. 2005 Jan 1;30(1):1-4. PMID: 15626973

10: Hadler NM. "Fibromyalgia" and the medicalization of misery. J Rheumatol. 2003 Aug;30(8):1668-70. PMID: 12913919

11: Hadler NM. Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic algorithms. Do some labels escalate illness in vulnerable patients? Postgrad Med. 1997 Aug;102(2):161-2, 165-6, 171-2 passim. PMID: 9270707

12: Hadler NM. Fibromyalgia: La Maladie est Morte. Vive le Malade! J Rheumatol. 1997 Jul;24(7):1250-1; discussion 1252. PMID: 9228119

13: Hadler NM. A critical reappraisal of the fibrositis concept. Am J Med. 1986 Sep 29;81(3A):26-30. PMID: 3532782

14: Wolfe F, Rasker JJ. The Symptom Intensity Scale, fibromyalgia, and the meaning of fibromyalgia-like symptoms. J Rheumatol. 2006 Nov;33(11):2291-9. PMID: 16960921

15: Wolfe F. From the outside of Plato's cave. Rheumatology (Oxford). 2004 Jan;43(1):112-3; author reply 113. PMID: 14681567

16: Wolfe F. Stop using the American College of Rheumatology criteria in the clinic. J Rheumatol. 2003 Aug;30(8):1671-2. PMID: 12913920

17: Wolfe F, Skevington SM. Measuring the epidemiology of distress: the rheumatology distress index. J Rheumatol. 2000 Aug;27(8):2000-9. PMID: 10955344

18: Wolfe F. The fibromyalgia problem. J Rheumatol. 1997 Jul;24(7):1247-9. PMID: 9228118

19: Wolfe F. The relation between tender points and fibromyalgia symptom variables: evidence that fibromyalgia is not a discrete disorder in the clinic. Ann Rheum Dis. 1997 Apr;56(4):268-71. PMID: 9166001

20: Ford CV. Somatization and fashionable diagnoses: illness as a way of life. Scand J Work Environ Health. 1997;23 Suppl 3:7-16. Review. PMID: 9456062

Enjoy! Dr. Anymouse (talk) 16:38, 24 November 2008 (UTC)

[unindent] See also the "Why such controversy" article from Goldenberg which is referenced in the text. It is the best overview of the controversy (and most reliable source). The NYT is a respected source as well, and shows that the controversy is still alive and well. --sciencewatcher (talk) 16:55, 24 November 2008 (UTC)

What about Mediation?

Between the edit warring and the non-productive talk page discussions, it seems that we are having a hard time finding consensus. What about mediation? It seems to be a logical next step in resolving this apparently intractable dispute. What say you? Dlabtot (talk) 18:06, 23 November 2008 (UTC)

As far as I can see, everyone apart from DrAnymoose recognises the need for the controversies to be in the article and we are working together to get the correct NPOV wording. Mr Anymoose, however, seems to be doing all he can to remove the controversies. His recent edits and comments have been less than useful. See for instance the revert he just did with the comment "sigh", and he admits he is an "unrepentant partisan". --sciencewatcher (talk) 18:15, 24 November 2008 (UTC)

For once, try not to launch personal attacks on other editors. Focus on the content. Guido den Broeder (talk, visit) 18:55, 24 November 2008 (UTC)

If there where only one editor with a desire to obscure the controversial nature of this diagnosis, perhaps I would be more hopeful. At any rate, I don't think the necessary improvements to the article will happen without formal dispute resolution. Time will tell. Good luck. Dlabtot (talk) 19:11, 24 November 2008 (UTC)

Gee whiz, fellahs: you mean having the proposition "Fibromyalgia is a controversial diagnosis..." appear in the lead PLUS an entire subsection devoted to the matter is insufficient for yall? Gosh, maybe you should consider initiating a whole Wikipedia article dedicated to the topic of sociological epiphenomenon of 'controversy' surrounding medical disorders for which substantial (and substantiating) evidence exists to explain the phenomena associated with them. Heck, I got a whole list of those I'd be willing to share with you.

Let's see, there's malaria, epilepsy, Parkinson's disease, schizophrenia, major depressive disorder, Huntington's chorea, asthma, porphyria, Kuru...

On the other hand, p'raps your crusading ... er, editorial diligence ... might take you in the direction of the dangers associated with fluoridation of the public water supply, Morgellon's syndrome... impotence secondary to alien abduction. You know, really important stuff. Dr. Anymouse (talk) 19:40, 24 November 2008 (UTC)

Your sarcasm in neither useful nor humorous. What has any of the medical articles you've mentioned have to do with this article? OrangeMarlin ^{Talk• Contributions} 23:04, 24 November 2008 (UTC)

The point being there is ample precedence in medical history for the existence of 'controversy' surrounding a disorder whether of a spiritual nature (She is possessed of demons! --> epilepsy) or misconstrual based on limited technologies (He has fever from breathing swamp gas! --> malaria). Evolving technologies afford novel insights. We are at that moment in FM. The issue of 'controversy' as it is construed/interpreted by my esteemed colleagues is therefore anachronistic. The true controversy surrounding FM has to do with which of the demonstrated pathophysiological processes is responsible for symptom expression and whether there is more than one type or sub-group. The Hadler/Ehrlich material is historical curiosity. They are dead men walking (figuratively speaking) , they just don't know it yet, although judging by Hadler's recent radio interview on the Diane Rhem show, he has seen the writing on the wall. Dr. Anymouse (talk) 00:55, 25 November 2008 (UTC)

Dr. Wolfe's perspective/dialectic as content.

I have a question I would like to hear commentary on. The current section on Controversy contains this line:

"Dr. Frederick Wolfe, the lead author of the 1990 paper that first defined the classification criteria for fibromyalgia, has since been quoted as saying he has become cynical and discouraged about the diagnosis and that he now considers the condition a physical response to stress, depression, and economic and social anxiety." (emphasis added) I added the observations regarding the impacts of stress on the brain as a means of demonstrating that, gee whiz, Wolfe appears to be right: stress does cause a physical change (i.e. atrophy, metabolite abnormalities) and (gosh!) these insights led to not just one but two investigations that appear to lend corroborating evidence. (I know: the horror, the horror...)

As it currently stands, the remaining text of my addition appears rather out of place since it was originally meant to have the observations from basic science as a bridging device. I guess the basic question is: yes, there are controversies, but they are in large part groundless and -- insofar is this article is concerned -- pathetically hypo-documented....so, is there some Wiki-policy about not addressing "controversies" when they are documented? If so, please direct this (sniff) wiki-noob towards such documentation. OTW... Dr. Anymouse (talk) 20:02, 24 November 2008 (UTC)

Your original research, your synthesis of and the conclusions you draw from primary sources - none of that belongs in this article. I would suggest a review of WP:NPOV, WP:V, and WP:OR. Dlabtot (talk) 20:46, 24 November 2008 (UTC)

It is often the nature of controversies that one side is groundless, so I'm not too concerned about that. Keeping a section that indicates controversy is minor and opposing views have little merit might in fact be beneficial to the neutrality of the article, so as long as the section is not empty I'm inclined to let it stay. And Wolfe reconsidering, however misguided, is by itself somewhat notable, I guess. Guido den Broeder (talk, visit) 20:57, 24 November 2008 (UTC)

Uh, actually the 'original research' to which my esteemed colleague Dlabtot is referring appears in a peer-reviewed article, wch is cited in what remains of the original paragraph, i.e. Wood et al., Hippocampal Metabolite Abnormalities in Fibromyalgia, &c. The 'original' synthesis upon wch this line of research was based (i.e. FM is related to stress-induced changes in hippocampal function) was likewise published in peer-reviewed form (Wood PB. Fibromyalgia: A Central Role for the Hippocampus, J Musculoskeletal Pain, 2004). So it would appear that corroborating evidence gained via application of the scientific method appears sadly unappreciated in these quarters, as does the idea of critical analysis of extant scientific literature. (Oh, and I get why Goldenberg has become the touchstone for yall: the stuff yall keep quoting is available for free via PubMed. Word: there's a lot more available on the subject -- problem is, you will have to actually get up from your laptop, go to the local medical resource library, look it up and read it. Don't be afraid: the reference librarian probably won't bite you. Dr. Anymouse (talk) 21:08, 24 November 2008 (UTC)

Anymouse, please review WP:NPA before continuing your uncivil personal attacks against a good faith editor like Daibtot. OrangeMarlin ^{Talk• Contributions} 23:01, 24 November 2008 (UTC)

Gee, OM, I was actually aspiring to the type of humor I've enjoyed on my talk page left by none other than yourself! Maybe that's the problem: this is all supposed to be serious stuff out here, right? And the User Pages are private...except I got a warning on my User Page related to action by my esteemed colleague Dlabtot, so there seems to be some sort of blur between public/private space. Hence the humor. Ha. Ha. Dr. Anymouse (talk) 23:14, 24 November 2008 (UTC)

So...uhm, OrangeMarlin, sir, would you care to weigh in on the matter that inspired this section, or am just going to get a knuckle rapping? Dr. Anymouse (talk) 00:53, 25 November 2008 (UTC)

Misrepresentation of sources

Concerning this edit. Dr. Anymouse, where in the cited source([1]) does Goldenberg say or imply anything like your insertion "despite evidence to the contrary"? Is this really something from the cited source, or is it your personal opinion? Dlabtot (talk) 20:52, 24 November 2008 (UTC)

Goldenberg refers to hormone studies that provide evidence for new hypotheses (not necessarily his, though). Guido den Broeder (talk, visit) 21:35, 24 November 2008 (UTC)

Which has no relation to the fact that his paper does not contain any constructs such as: "critics assert x, despite evidence to the contrary" or "critics, who are ingoring the evidence", etc. This is not a conclusion that Goldenberg asserts, rather, it looks likes Dr. Anymouse's opinion about the controversy. I look forward to his polite and respectful reply to my inquiry. Dlabtot (talk) 21:41, 24 November 2008 (UTC)

The dated reference upon which the gentleman is building his thesis appeared in 1995, whereas the study I cite was published in 2002. So, in the absence of either psychic powers or a Tardis, I’m thinking the content of the append is not “something from the cited source” but instead a valid aspect of the overarching (overwrought?) proposition that “Fibromyalgia is a controversial diagnosis…”

More to the point, Goldenberg – who has devoted his life to FM research and treatment – answers the question “Do diagnosis and treatment improve outcome?” by stating that in his experience “…the label of fibromyalgia provides a structure for patient understanding and a model for treatment.” He goes on to observe “[m]ost patients with fibromyalgia have been shuttled back and forth from numerous physicians, and have undergone numerous costly and sometimes dangerous tests and ineffective treatment before the diagnosis” and that “the average duration of symptoms before the diagnosis of fibromyalgia is five years.”

Thus, Goldenberg's intention by taking the time out of his busy practice to field what we can safely assume was an unsolicited editorial review was to confront the very proposition that Dlabtot and Sciencewatcher appear hell-bent on including as primary content, namely the notion that somehow FM is a clinically invalid construct. (But then I have to assume my esteemed colleague was only turning my crank by asking such a question because he already knew all this from his own critical appraisal of the article, right?) Moreover, the article I cited by White et al (2002) was doubtlessly inspired by the very sentiments Goldenberg expressed and thus represent a logical continuum.

This is where our little rubber bubble here in cyber space meets the big bad road. Wikipedia has , for better or worse, become a major touchstone to inform the cultural gestalt. (How many premedical students do you think familiarize themselves with topics by plugging words they hear in class into their hand helds? I'm thinking more than a few...) By insisting that ‘controversy’ appears in the article lead – thereby implying persons affected by FM are, as a colleague of mine from Infernal Medicine once stated ‘lazy, bon-bon eating egg-pumpers who have nothing better to do with their time but sit on the couch and complain’—we can be assured of perpetuating the trauma associated with stigmatization of some 6+ million American women. Wonderful! And never mind the fact that the science of FM is one of the most rapidly expanding branches of medical science (this despite negligible funding from the NIH): by dis-incentivizing larval medical professionals from taking the time to inform themselves of this ‘controversial’ disorder, we can also take satisfaction in knowing that we have played a role, however indirectly, in exposing other human beings to material risks involved in invasive diagnostic procedures and unnecessary medical therapies. (Hey, did you hear the one about the rheumatologist who kept increasing the dose of his patient’s methotrexate and prednisone because he thought her fibromyalgia was a manifestation of sero-negative lupus following her spinal tap? Man, talk about a knee slapper!)

So, by all means, let us make the sociological phenomenon of ‘controversy’ surrounding FM a prominent part of the Wikipedia article! After all, we would be remiss in our social irresponsibility as armchair documentarians were we to do otherwise.

Respectfully submitted, Dr. Anymouse (talk) 22:32, 24 November 2008 (UTC)

Does Goldenberg say that the critics are ignoring contrary evidence, or not? Dlabtot (talk) 22:45, 24 November 2008 (UTC)

You are not quoting Goldenberg; you are fielding a proposition based on his writing, to which I am appending a valid logical continuum. Therefore the question is not germane to the task at hand. Does that satisfy the inquiry? Dr. Anymouse (talk) 22:50, 24 November 2008 (UTC)

It seems pretty clear that the reason you are unwilling to address my question is that you're fully aware that you've misrepresented the source. I really think it is time for mediation because while you are typing comments here on this talk page, you are not actually engaging in a dialogue. Dlabtot (talk) 23:04, 24 November 2008 (UTC)

While you're thinking about that, please explain why you feel the topic of 'controversy' is so essential to the article in question as to appear in redundant fashion. What benefit is derived from this, and who is the beneficiary? Dr. Anymouse (talk) 22:53, 24 November 2008 (UTC)

I suggest a review of WP:NPOV and WP:LEAD Dlabtot (talk) 23:04, 24 November 2008 (UTC)

Why do you refuse to answer Diabtot's fairly simple question? By doing so, it appears that one can only conclude that you have interpreted the citation in a manner that is not actually written in the citation. OrangeMarlin ^{Talk• Contributions} 23:00, 24 November 2008 (UTC)

I suggest Anymouse review WP:NPA, WP:CIVIL, WP:POINT before we can even get to discussing what constitutes neutral editing. OrangeMarlin ^{Talk• Contributions} 23:06, 24 November 2008 (UTC)

This is called misdirection. http://en.wikipedia.org/wiki/Misdirection. Dr anymouse consistently flowers his replies with irrelevancy. He ignores questions put to him and steers the conversation toward different channels. Maybe he simply doesnt have an answer other than his own opinion. Shaun3001 (talk) 23:08, 24 November 2008 (UTC)

Yeah I noticed that. He should work in Public relations, where individuals are trained to answer a question, just not necessarily the one you ask. OrangeMarlin ^{Talk• Contributions} 00:40, 25 November 2008 (UTC)

Okey-doke: no, Goldenberg did not say "despite evidence to the contrary." Question answered, yes? But that is a trivial point. I would, as suggested, be 'misrepresenting the source' were I to insert into a quote or other direct form of attribution something along the lines as my append to the proposition. However, as stated, Dlabtot is not quoting Goldenberg but is rather fielding a proposition that he has derived from an article Goldenberg has authored. There is ample...no, vast...precedence for synthesizing two sources in a single propositional statement in scholarly writing. If you/yall would prefer, the propositional sentence can be edited to have both citations occur at the terminal point of the statement, or we can agree to redact the content to the appropriate subheading as is precedent in several other Wikipedia articles. According to my review of Wikipedia content, having this content appear in the lead is unprecedented. Why-oh-why does Fibromyalgia merit such special treatment -- pray tell! Dr. Anymouse (talk) 23:11, 24 November 2008 (UTC)

Well that was an answer to some question, just not sure what part of the known universe it was asked. OrangeMarlin ^{Talk• Contributions} 00:41, 25 November 2008 (UTC)

...my esteemed colleague Dlabtot asked "Does Goldenberg say that the critics are ignoring contrary evidence, or not?" my esteemed colleage OrangeMarlin asked "Why do you refuse to answer Diabtot's fairly simple question?" So, okay: I answered the question. Not that I see anyone rushing to address the issues I am posing with regard to the necessity for 'controversy' to figure prominently in this article or why my amply referenced amplification of the Controversy section was redacted despite the materials I summarized appearing in peer-reviewed journals (above). Dr. Anymouse (talk) 00:49, 25 November 2008 (UTC)

Something tells me that you did not take my advice to review WP:LEAD. So I will provide a salient quote: The lead should be able to stand alone as a concise overview of the article. It should establish context, explain why the subject is interesting or notable, and summarize the most important points—including any notable controversies that may exist. That should answer your question as to why the controversy should appear in the lead. Dlabtot (talk) 02:35, 25 November 2008 (UTC)

It looks like Dr. Anymouse also needs to read WP:OR and WP:SYNTH. From what I've read here, the content he added can be removed as violations of these policies. -- Fyslee / talk 03:27, 25 November 2008 (UTC)

Can we stop the personal attacks please? This is not helpful. Clearly, Dr. Anymouse disagrees that the controvery is notable, and while I personally think it may just pass the notability criterium, I can easily understand why. Guido den Broeder (talk, visit) 10:17, 25 November 2008 (UTC)

I suggest a stop to baseless and ill considered accusations. Asking an editor to follow policy is not a personal attack. Dlabtot (talk) 15:58, 25 November 2008 (UTC)

I sincerely appreciate Guido den Broeder's comments. However, for the sake of clarification: I do not disagree with the inclusion of a section to document the controversies that have surrounded the disorder per se. A review of earlier discussion(s) bears this out -- in fact, I rather like the idea of highlighting the issue because it makes those who have been so vocal in their opposition of the disorder look like uninformed boobs in the face of the abundance of evidence documented herein.

On the other hand, I do think it is socially irresponsible to feature this issue so prominantly in the article as to facilitate dismissal of the disorder as a valid medical entity based in large measure on anachronistic and/or simplistic criticisms by individuals employed in large measure by the insurance industry and the waffling of a dear but misguided senior researcher. (As I understand it, Galileo also recanted some of his work under duress from his...er...colleagues.) As the revered Dr. Don L. Goldenberg observes in his much cited editorial review, ignorance of the diagnosis and neglect of the population of patients to wch this article applies has real costs for all of us -- on the order of billions (yes, billions) of dollars in unnecesary medical evaluations (bear this in mind next time you have to pay your healtcare insurance premiums, esteemed colleagues) -- not to mention the trauma and potentially life-threatening risks borne by those affected by the disorder who are forced to rely on smug, dismissive clinicians in order to be diagnosed and treated.

Thus, it seems to me that it would behoove all of us to promulgate a greater appreciation for the reality of the disorder by documenting the objective findings associated with it rather than spotlighting what will surely become an historic embarrassment to its detractors merely in the interest of "adherence to wiki-policy." Dr. Anymouse (talk) 12:44, 25 November 2008 (UTC)

Reverts by Orangemarlin

A whole string of my yesterday's edits got reverted by Orangemarlin. Since he provided no explanation, let's collect some opinions.

1. [2]
2. [3]
3. [4]
4. [5]
5. [6]
6. [7]
7. [8]
8. [9]
9. [10]
10. [11]

If your edits were reverted as well, feel free to add them to the list. Guido den Broeder (talk, visit) 11:18, 25 November 2008 (UTC)

It was actually somewhat amusing that following a day of intensive work on the part of several of us that he came on board late in the day (US EST) and summarily reverted a majority of what was done in part to a rather controversial pair of statements by our esteemed colleague Sciencewatcher. I thought I caught a whiff of socks, but then maybe that's just my paranoia speaking (?). I'd hate to be accused of jumping to conclusions or otherwise fall afoul of some esoteric WP policy landmine. Dr. Anymouse (talk) 12:54, 25 November 2008 (UTC)

No socks, but this tandem has been seen in action before. I've reported the editwarring but, as expected, to no avail. Guido den Broeder (talk, visit) 13:35, 25 November 2008 (UTC)

I say, kudos to Orangemarlin. He's done some good work here. Dlabtot (talk) 16:04, 25 November 2008 (UTC)

No, Orangemarlin is not me and I haven't even spoken to him about this article. I've temporarily stopped editing this article because it's getting counterproductive. I notice that Mr Anymouse has again inserted the irrelevant material about stress that is unrelated to FMS into the article. --sciencewatcher (talk) 16:07, 25 November 2008 (UTC)

Mr Anymouse here: would you please indicate where the offending material might be? Dr. Anymouse (talk) 16:12, 25 November 2008 (UTC)

I'm asking for a block of both Guido and Anymouse for their personal attacks and uncivil behavior. OrangeMarlin ^{Talk• Contributions} 16:15, 25 November 2008 (UTC)

"If I fall down an open manhole, that's tragedy. If it happens to you, that's comedy." - Woody Allen. Dr. Anymouse (talk) 16:28, 25 November 2008 (UTC)

Mr Anymouse: here is the info that doesn't appear to be relevant: "This proposition was based in part on the observation that preclinical studies in non-human primates have shown that exposure to psychosocial duress results in material changes to the very tissues of the brain, including atrophic and metabolic changes in the hippocampal complex.[33][34]". --sciencewatcher (talk) 16:43, 25 November 2008 (UTC)

I agree with Sciencewatcher that this info doesn't belong in the article. I understand that it was added to counterbalance some pov, but it is better to do deal with that directly. Guido den Broeder (talk, visit) 16:50, 25 November 2008 (UTC)

Actually, I think Sciencewatcher has a valid concern and I'm grateful for the opportunity to discuss this. The content you are concerned about is derived from Wood's hypothesis regarding stress-induced hippocampal changes as the basis of fibromyalgia pathophysiology, wch is the subtopic of the paragraph in which the content appears (the section heading is Hypotheses Regarding Causation).

So, the strategy used to elaborate the paragraph in question and others in the section went like this: 1. Introduce the hypothesis including citation of the primary document in wch it appears (i.e., Wood, JMP 2004); 2. present amplifying background material derived from the primary source including citations used by the author (Uno et al, 1989; Lucasson et al, 2001) ; and 3. discuss the weight of extant evidence is support of the hypothesis in question. In this case, the two articles related to changes in hippocampal metabolites (i.e. Emad et al, 2008; Wood et al, 2008) were directly inspired by the original hypothesis as discussed by the respective authors. So, that is why the material is there, because it provides an illustration of the scientific method from hypothesis generation to critical appraisal of corroborating data.

If you take issue with this approach, please explain the rationale behind your perspective. Also, if you like, I would be happy to provide PDF copies of the original documents for your inspection if that would be helpful. Thanks! Dr. Anymouse (talk) 17:50, 25 November 2008 (UTC)

Let me just put something in here: I've looked extensively into the research into the HPA axis with regards to CFS, which is an illness related to FMS. (Note: I'm not a FMS or CFS researcher). At first I was convinced that the HPA axis was central and caused all the symptoms, but later research has shown that it's not that clear-cut, with different patients showing different types of HPA axis activation (some normal, some underactive, some overactive). Although I haven't looked into the HPA axis and fibromyalgia in great detail, it is my understanding that there are similar uncertainties. The same goes for abnormalities in various parts of the brain. So while it may be worth mentioning these things briefly, you need to be careful that you aren't just mentioning something that is still just speculation (e.g. just one unreplicated study). In the CFS article we mostly try to quote comprehensive reviews. Unless the info is relevant and carries sufficient weight, it's usually better to just leave it out so that the article doesn't get too bloated. Also, one of the studies you quoted doesn't actually mention FMS, so you might want to check out WP:SYNTH because I think you may be falling foul of that policy. --sciencewatcher (talk) 18:46, 25 November 2008 (UTC)

Well, I am pretty intimately involved in FM research, so I feel comfortable with the material. If you have any questions, I'd be happy to discuss these with you, if it would be of any help in your efforts (short of 'outing' myself, natch). If you would, please be a bit more specific than "one of the studies you quoted" -- I will be very happy to redact if the reference is inappropriate. Please note, however, that in the field of community-based FM epidemiology research, chronic widespread pain (CWP) is used as a proxy for FM in the absence of diagnostic physical examination. Hard to do when you are conducting a postal survey of thousands of souls.  ;) Dr. Anymouse (talk) 18:57, 25 November 2008 (UTC)

I meant this bit: "This proposition was based in part on the observation that preclinical studies in non-human primates have shown that exposure to psychosocial duress results in material changes to the very tissues of the brain, including atrophic and metabolic changes in the hippocampal complex.[33][34]" --sciencewatcher (talk) 19:37, 25 November 2008 (UTC)

Got it. Again, the purpose of including this material was to shed light on the author of the primary document's development of his hypothesis. I thought it would serve to bridge between stating the hypothesis and the extant evidence that corroborates it. Whatcha think? Dr. Anymouse (talk) 21:04, 25 November 2008 (UTC)

As I said, I think you should read WP:SYNTH. And I think the entire stress section really needs someone else to look at it to see what is appropriate there. --sciencewatcher (talk) 21:09, 25 November 2008 (UTC)

@Dr. Anymouse: it does shed light, and someone should investigate the matter more closely and write about it, but not in Wikipedia. :-) Guido den Broeder (talk, visit) 22:03, 25 November 2008 (UTC)

A fresh opinion

Hi; I'm a neuroscientist who doesn't claim to know anything about this disease, but my attention was drawn by the posts on ANI. Having spent an hour or so Google-scholaring, it looks clear to me that the trend of the recent literature is very strongly in the direction of accepting the reality of the condition. In particular, this publication seems authoritative, although it isn't currently cited in the article. I suggest that although a mention of skepticism clearly belonged in the lead a year ago, it probably doesn't belong there any more, but should be reserved for the body of the article. looie496 (talk) 19:40, 25 November 2008 (UTC)

I don't whether or not 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, is wrong to say " Some of us in those days thought that we had actually identified a disease, which this clearly is not ", but it should be noted that the NY Times article in which this quote appears is from January of this year, 2008. Which imho pretty much settles the question of whether there is currently a notable controversy. The paper you cite from 2007 does not actually seem to address the question of whether fibromyalgia constitutes a disease, simply saying, " Fibromyalgia does not have a distinct cause or pathology. Dlabtot (talk) 20:45, 25 November 2008 (UTC)

If that is the full extent of the current controversy, then it is hardly at odds with Looie496's impression, which coincides with my own. Guido den Broeder (talk, visit) 22:14, 25 November 2008 (UTC)

^ Not sure what you mean by this statement. The controversy is the one described by the cited sources: [12] and [13]. I don't really see what anyone's impressions have to do with it. Dlabtot (talk) 22:38, 25 November 2008 (UTC)

So can we agree then that the rest of the current controversy section (comorbidity and such) should be moved to a different section? Guido den Broeder (talk, visit) 12:05, 26 November 2008 (UTC)

Did you see the latest version? I think (hope) that it meets with Dlabtot's criteria regarding the Wolfe/NYT issue and also gives additional insight regarding the issues facing the FM research community. Dr. Anymouse (talk) 13:25, 26 November 2008 (UTC)

Ah, that's more like it. I would (re)move the sentence about overlap, too. Fibromyalgia as a comorbidity to ME/CFS is well accepted and not a controversy at all. Guido den Broeder (talk, visit) 13:43, 26 November 2008 (UTC)

Timeline

The current text contains a 'timeline' which has been doubly tagged for months. I don't see the additional value of this timeline; half of it is already in the history section, and the weight of the rest is debatable. Since the article is already very long, I suggest to drop it. Guido den Broeder (talk, visit) 12:22, 26 November 2008 (UTC)

I totally concur. I think I know who put this in. You will note the content has a lot to do with the National Fibromyalgia Assoc (USA). The editor who is responsible for this content might consider initiating a WP article dedicated to the organization rather than having it featured here as an odd append.Dr. Anymouse (talk) 13:20, 26 November 2008 (UTC)

Yes, that sounds like a good idea. I don't know much about the association, but it could well be notable enough to have its own article, or else there could be a general article on fibromyalgia advocacy. --Guido den Broeder (talk, visit) 13:39, 26 November 2008 (UTC)

I have removed the timeline, as nobody objected. Guido den Broeder (talk, visit) 11:57, 28 November 2008 (UTC)

Archive?

I am soliciting input regarding a proposal to archive some of the content of this Discussion section, which has become cumbersome to navigate. Please review the materials above and consider where the line for inclusion might be drawn most appropriately. Thanks! Dr. Anymouse (talk) 13:40, 26 November 2008 (UTC)

I suggest archiving everything before 'neutrality and balance'. Feel free to go ahead. Guido den Broeder (talk, visit) 12:00, 28 November 2008 (UTC)

Prognosis

The first part of the prognosis section is taken literally from Goldenberg, except for the inaccuracy where the article leaves out that it concerned patients in tertiary referral centers only. AFAIK this is a violation of copyright and should therefore be rephrased (and corrected), like I tried [14], but User:Orangemarlin keeps reverting, as he also keeps readding erroneous pmid numbers and replacing sources with old fact tags. Let me hear your opinions. Guido den Broeder (talk, visit) 23:48, 26 November 2008 (UTC)

I think I put that info in. I agree it should not have been copied literally, so feel free to rewrite it. I did that because of [1] laziness and [2] taking info directly from reviews seemed to be the easiest way to avoid an edit war. I don't think taking one sentence is a copyright violation though. --sciencewatcher (talk) 00:44, 27 November 2008 (UTC)

Thanks. Laziness is an appreciated quality. :-) Guido den Broeder (talk, visit) 12:06, 27 November 2008 (UTC)

"Not directly life-threatening"

Currently the lead contains this sentence: "The disorder is not directly life-threatening" While strictly true, it is also somewhat misleading when left alone. We need more about causes of death related to fibromyalgia. Does the article cover suicide risk and other comorbid conditions adequately? Here is something to peruse:

• Google search: fibromyalgia+suicide

• Some very interesting statistics:

There were 48 deaths during more than 5,000 person-years of follow-up. This number didn't represent an increase in overall mortality, compared with that of the Danish general population; however, several specific causes of death stood out. Among the 1,163 women with confirmed fibromyalgia, for example, the rate of suicide was ninefold greater than in the general population, as reflected in Danish mortality register statistics. The suicide rate among the 106 women with possible fibromyalgia was increased 20-fold.
Similarly, mortality due to cirrhosis of the liver was increased fivefold in women with confirmed fibromyalgia and 18-fold in those with suspected fibromyalgia. Mortality due to cerebrovascular disease was fourfold greater among women with confirmed fibromyalgia than in the general population, according to Dr. Dreyer of the Parker Institute at Frederiksberg Hospital, Copenhagen.
Fifty cancers occurred 1 year or more after initial university evaluation for fibromyalgia. Rates of several malignancies were elevated. Women with confirmed fibromyalgia had a four times greater ageadjusted incidence of non-Hodgkin's lymphoma than in the general population, a three times increased rate of breast cancer prior to age 50, and a 23-fold elevation in laryngeal cancer.
Among women with possible fibromyalgia, the rate of breast cancer prior to age 50 was increased 6-fold, breast cancer at any age was increased 5-fold, and there was an 11-fold elevation in lymphatic or hematologic cancer.
There were four cases of lung cancer among the 84 men with confirmed fibromyalgia, translating into an incidence rate that was 13-fold greater than in the general population as reflected in Danish cancer register statistics.
It therefore makes sense to carefully examine all patients diagnosed with fibromyalgia or suspected fibromyalgia for possible malignancies as well as for risk factors for liver disease, cerebrovascular disease, and suicide, she said.

-- Fyslee / talk 18:03, 9 November 2008 (UTC)

Proposed addition of risk and mortality findings

This source and its findings need mentioning. I propose the following to be added (I'm not sure where):

• Two scientific studies have established a significant association, but not necessarily causation, between fibromyalgia and a number of risk and mortality factors, such as cancers, suicide, cirrhosis of the liver, and cerebrovascular disease.

Please improve this and discuss it here. -- Fyslee / talk 08:59, 27 November 2008 (UTC)

Quick question

The article says "As noted above, FM has been commonly referred to as a "stress-related disorder"" but on what I can see the references do not really support the word "commonly". Did I miss something in them, or should we delete the word commonly? --BozMo talk 11:48, 28 November 2008 (UTC)

If you look at the history, there were originally 2 references there, but it looks like someone changed it to say "as noted above" due to the separate stress section and the refs were removed. But it doesn't say "commonly" anywhere in the stress section, nor in the refs that were originally there as far as I can see. --sciencewatcher (talk) 16:02, 28 November 2008 (UTC)

review

Guido re-added the review that I deleted. It was deleted because [1] JCFS is not a reliable source (it is now defunct) and [2] it does not appear in pubmed and [3] the review does not show that low dose cortisol is effective for treating FM. Please discuss here before re-adding the review. --sciencewatcher (talk) 18:07, 18 December 2008 (UTC)

Prognosis

Hi Sciencewatcher -- I read the Goldenberg review, and didn't see anything in it that stated that "outcome is directly related to psychosocial factors", but may have missed it. Could you point me to the passage you're relying on here? I don't actually see how the review could be read as saying this when its basic message is that FM usually gets neither much better or much worse. Looie496 (talk) 17:15, 20 December 2008 (UTC)

It's not in the abstract, but it is in the full text. Just click on the link and you can see the free full-text. I basically just took the text verbatim, as any rewording it likely to cause disagreement. Just search for the word "social" in the full-text and you'll find it.

In regard to your question about how we can discuss what causes recovery if there is no recovery: good point. I think what Goldenberg is saying is that while there is no agreed treatment, many patients do improve (and some recover), and the factors listed are the ones that have been shown to improve the chances of improvement.--sciencewatcher (talk) 17:49, 20 December 2008 (UTC)

Found it, thanks. I had scanned the full article, but missed that line. Looie496 (talk) 18:32, 20 December 2008 (UTC)

From Goldenberg (Arch Intern Med, 1999)

CONCLUSIONS

Fibromyalgia is a clinical syndrome [...] Medicines that affect pain perception, sleep, and mood have been useful and should be integrated with activity, exercise, and educational programs. Most patients with FM observed in tertiary referral centers report little change in their symptoms over time. The outcome is directly related to psychosocial factors, including past and current psychological distress and work status or disability issues. As with any chronic illness, patients in the community do better than those observed in specialty clinics. Ten percent to 30% of patients describe being work impaired from FM. Physicians should discourage inactivity and disability because, if these are prolonged, there is an adverse effect on prognosis. Finally, patients have found a diagnostic label to be reassuring, and the diagnosis has decreased costly testing and health care use. [...]

Emphasis added. Dr. Anymouse (talk) 14:52, 21 December 2008 (UTC)

Addendum: I just wanted to add how hysterical I think the last bit of edit warring has been given the parties that are involved! Bwahahahaha...ha. Dr. Anymouse (talk) 17:58, 21 December 2008 (UTC)

Fiber Muscle Pain

How does this look? It seems in keeping with the recent edit history, don't you think?

Fibromyalgia (FM)is a disorder classified by the presence of chronic widespread pain and a heightened and painful response to gentle touch (tactile allodynia). Other core features of the disorder include debilitating fatigue, sleep disturbance, and joint stiffness. The name itself is an antiquated neologism that was created by synthesizing Latin cognates (fibre = fiber; myos = muscle; algos = pain), a fact apparently taught in Nursing School curricula in Canada. More to the point, persons affected by the disorder frequently experience a range of other symptoms besides pain... 96.241.101.202 (talk) 12:38, 29 December 2008 (UTC)

It looks like a bulky bit of unsourced editorializing. I have answered your query on my talk page, and also left a note on your talk page. Please don't get yourself in trouble so early in your career here. Discuss this here and work it out with other editors. You have already gone to 3RR and will be in violation if you touch this issue at all on the article. My talk page has more to say about the matter. -- Fyslee (talk) 15:35, 29 December 2008 (UTC)

Fibromyalgia and SSRIs

From Arnold LM (Biology and therapy of fibromyalgia: New therapies in fibromyalgia, Arthritis Therapy & Research 2006):

Systematic reviews

Three recent meta-analyses of fibromyalgia pharmacological trials assessed the efficacy of medications that inhibit the reuptake of serotonin and/or norepinephrine. The first meta-analysis [16] assessed nine placebo-controlled trials of the cyclic drugs that inhibit the reuptake of both serotonin and norepinephrine, including the tricyclics amitriptyline [17-20], dothiepin, which is structurally similar to amitriptyline and doxepin [21], cyclobenzaprine [18,22-24], which possesses structural and pharmacological properties of other tricyclics [25], clomipramine [26], and the tetracyclic maprotiline [26]. Seven outcome measures were assessed, including: the patients' self-ratings of pain, stiffness, fatigue and sleep; the patient and the physician global assessment of improvement; and tender points. The largest effect was found in measures of sleep quality, with more modest changes in tender point measures and stiffness. Thus, the most consistent improvement could be attributed to the sedative properties of these medications.

The results of another meta-analysis of randomized, placebo-controlled studies of cyclobenzaprine was consistent with the Arnold and colleagues [16] meta-analysis. Cyclobenzaprine treatment resulted in moderate improvement in sleep, modest improvement in pain, and no improvement in fatigue or tender points [27].

A third meta-analysis of antidepressants in the treatment of fibromyalgia [28] evaluated 13 trials of antidepressants, most of which studied the cyclic drugs amitriptyline [17-20,26,29-32], clomipramine [26], and maprotiline [26]. The meta-analysis also included trials of the selective serotonin reuptake inhibitors (SSRIs) fluoxetine [20,33] and citalopram [34], as well as a reversible inhibitor of the monoamine oxidase-A enzyme, moclobemide [29], and the dietary supplement S-adenosylmethionine [35,36]. Outcome measures included the number of tender points, and patients' self-ratings of pain, sleep, fatigue, and overall well being. The pooled results showed a significant symptomatic benefit of antidepressants that was moderate for sleep, overall well being, and pain severity, and mild for fatigue and number of tender points. The magnitude of benefit was similar to that found in the Arnold and colleagues [16] meta-analysis. Because only three trials of SSRIs were included in the meta-analysis, it was not possible to assess the relative efficacy of SSRIs.

The trials of SSRIs in fibromyalgia have shown mixed results, suggesting that medications with selective serotonin effects are less consistent than those with dual effects on norepinephrine and serotonin in the relief of pain associated with fibromyalgia. Citalopram, which has the highest selectivity for the serotonin reuptake transporters among the SSRIs, was not effective for the treatment of fibromyalgia in two small controlled studies [33,37]. On the other hand, the SSRIs fluoxetine and paroxetine CR, which may have additional effects on norepinephrine at adequate doses [38,39], have been shown to be effective for fibromyalgia in recent studies [40,41].

Although the meta-analyses indicated that the overall effect of the cyclic drugs on most symptoms of fibromyalgia was modest, possibly related to the low doses that were typically studied, tricyclics continue to be frequently recommended for the treatment of patients with fibromyalgia [42]. Furthermore, even at low doses, many patients experience problems with the safety and tolerability of these medications related to their anticholinergic, antiadrenergic, antihistaminergic, and quinidine-like effects [43].

Recently, fibromyalgia trials have focused on new selective serotonin and norepinephrine reuptake inhibitors (SNRIs), which are potent dual reuptake inhibitors but, unlike the tricyclics, do not interact with adrenergic, cholinergic or histaminergic receptors, or sodium channels, and, therefore, lack many side effects of tricyclics. Preliminary, open trials of the SNRI venlafaxine were promising [44,45], but one study, a six-week, randomized, placebo-controlled, double-blind trial of a fixed, low dose of venlafaxine (75 mg/day) [46], found that venlafaxine improved some but not all measures of pain. The short duration of this trial and low dose of venlafaxine may explain the discrepant results. To date, two randomized, placebo-controlled studies of the SNRI duloxetine and one study of the SNRI milnacipran in the treatment of fibromyalgia have been published, and are described below...

(Oh, and, just in case:)

Rottach KG, Schaner BM, Kirch MH, Zivotofsky AZ, Teufel LM, Gallwitz T, Messer T. Restless legs syndrome as side effect of second generation antidepressants. J Psychiatr Res. 2008 Nov;43(1):70-5.

relevant to...

Stehlik R, Arvidsson L, Ulfberg J. Restless Legs Syndrome Is Common among Female Patients with Fibromyalgia. Eur Neurol. 2008 Dec 9;61(2):107-111.

Background: The prevalence of restless legs syndrome (RLS) among the general population is 2-15%, and with fibromyalgia syndrome (FMS) 2%. Both RLS and FMS are more common among women. The aim of our study was to evaluate the prevalence of RLS in a group of female patients diagnosed with FMS and to compare the occurrence of symptoms of daytime sleepiness and experienced sleep disorders between fibromyalgia patients with or without RLS. Method: Three hundred and thirty-two female patients, 20-60 years old, diagnosed with FMS at Skönviks Rehab between 2002 and 2006, answered a questionnaire mailed to their home address. The questionnaire consisted of the international RLS study group criteria as well as of questions concerning symptoms of insomnia and daytime sleepiness measured according to the Epworth Sleepiness Scale. Results: Nearly 64% of the women were also suffering from RLS. More patients suffering from both RLS and FMS were affected by problems of initiating and maintaining sleep than those suffering from FMS only. More patients suffering from both RLS and FMS did not feel refreshed on awakening compared with those suffering from FMS without RLS. The patients with concomitant RLS and FMS were more often hypersomnolent than those suffering from FMS only. Conclusion: This study shows that 64% of a group of female patients diagnosed with fibromyalgia also concurrently suffered from RLS. Compared with patients who suffer from FMS only, patients with both FMS and RLS more often experience sleep disturbances and pronounced daytime sleepiness.

'Do the math....' 71.191.7.3 (talk) 22:15, 31 December 2008 (UTC)

Excellent, this is a good review - do you want to rewrite the section using this info? If not, I'll do it in the next few days. We just need to make sure the text is written in an understandable way, and not incomprehensible gobbledegook like before. --sciencewatcher (talk) 23:10, 31 December 2008 (UTC)

I believe the onus is on you to do so, as you are the one who deleted a relevant and well-referenced passage and substituted material from an inferior/dated citation. Enjoy! 71.191.7.3 (talk) 16:07, 1 January 2009 (UTC)

Just in case anyone doesn't know, 71.191.7.3 is the same ip address as DrAnymouse. Yes, I certainly will rewrite it, when I have time. However I certainly won't be in a hurry because I don't appreciate the ridiculous personal attack that you directed at me on my talk page, saying I must be paid by Eli Lily. So you will either have to live with my slightly imperfect edit, or the previous even more imperfect edit which not only didn't make sense but had old, primary sources and didn't actually reflect the current consensus.

Also, it looks like my wiki-stalking, vandalising plus.net user (Jane Bryant?) has reverted my change anyway. --sciencewatcher (talk) 19:16, 1 January 2009 (UTC)

Ah, but 'gobbledygook' is the benchmark of professional rapport. 71.191.7.3 (talk) 19:31, 1 January 2009 (UTC)

"Personal attack" It's a wiki-thang; you wouldn't understand. —Preceding unsigned comment added by 170.170.59.138 (talk) 01:42, 2 January 2009 (UTC)

Okay, I have rewritten it using the new review. See what you think. I also renamed it to antidepressants because it covers multiple antidepressants. --sciencewatcher (talk) 16:44, 2 January 2009 (UTC)

Reefer madness

This is hysterical: efforts to improve a medical article by deleting ill-founded, ill-referenced ... not to mention hypothetical ... considerations (I mean, a link to NORML, for chrissakes~!) and substituting information from a randomized controlled trial are being reverted by a petty bully and reinforced by Admin. Un-freaking-buhlievable. 71.191.7.3 (talk) 18:43, 5 January 2009 (UTC)

How come you're logging in as anon? Anyway, I agree with you that the current text needs fixed. In the current text there is a "9 patient" trial with no placebo and 5 of the patients dropped out due to side effects! --sciencewatcher (talk) 23:32, 5 January 2009 (UTC)

The changes were reverted because the IP (currently blocked) simply deleted a large amount of material without any explanation, and when others reverted, edit-warred to repeat the deletion, ignoring repeated requests to justify on the talk page. (I am just summarizing; I was not involved.) Looie496 (talk) 02:21, 6 January 2009 (UTC)

Yes I agree that he didn't go about it in the best way, but he does have a point about the dodgy cannabis research that's current in the article. --sciencewatcher (talk) 03:05, 6 January 2009 (UTC)

Hello, and Happy New Year. Will have a look at her material and incorporate it in a more acceptable manner. Dunno, though: maybe 'the Sheriff' wants the bit about NORML in the text? Or maybe there are ulterior motives: p'raps shabby science detracts from the overall credibility of the disorder> (Light bulb goes off...hmmm!) Seems out of character, but who knows... Thx Dr. Anymouse (talk) 19:34, 6 January 2009 (UTC)

Regardless of how right you are they way you went about it under your IP guise does not do you any favours and any sense you make will disappear in a cloud of wiki-lawyering. Fuck with the rules and you get bounced regardless of how well-intentioned or correct you are. --WebHamster 20:01, 6 January 2009 (UTC)

Thanks for the input, WH. I have attempted to edit the section on experimental drugs incorporating results from an RCT and also removing some questionable citations. I imagine my wikistalker will wikilawyer this into a muddle, so good luck. Please weigh in on this. Dr. Anymouse (talk) 23:36, 6 January 2009 (UTC) ps - Sciencewatcher - sorry for the confusion above. We have taken care of this issue.

Uhm...me again. @Looie496 - I thought my edit summaries served as an explanation(?) I have given my input on talk per above. So....what, do we take vote? Dr. Anymouse (talk) 23:54, 6 January 2009 (UTC)

When you've gotten into a revert war, you need more than explanations, you need consensus. If you would just list here the changes you would like to make and ask for reactions before making them, it looks like there's a good chance that most if not all of them would get approval. Looie496 (talk) 00:54, 7 January 2009 (UTC)

I'm pretty pissed off that Anymouse would choose to circumvent editing by using socks, but that's been handled as it should. Moving along here, in an article as contentious as this one, massive deletion of material requires some amount of discussion. So, why doesn't Anymouse propose what he wants to do here, and let's come to a consensus without the use of edit warring or socks. So, the ball is in your court Anymouse. OrangeMarlin ^{Talk• Contributions} 01:01, 7 January 2009 (UTC)

Causation Hypothesis->other hypotheses section - missing citations

This section is missing citations for several statements. Of particular interest to me is the first sentence. A google search found only copies of this wiki article.

Given the amount of research on the topic, it seems that all assertions in the article should have credible references. Does anyone know who added the items in this section, or does anyone have references to back up the claims? If not, the statements should be removed. 71.203.159.204 (talk) 02:47, 12 January 2009 (UTC)

I was actually thinking exactly the same thing earlier today (and no, I'm not the same person as 71.203.159.204 in case anyone is wondering). I did a few searches on pubmed but didn't come up with anything regarding the ATP deposition hypothesis. I haven't looked for references for the other "Other" hypotheses, but they all sound very dubious. I would suggest just removing the entire Other section, unless anyone has any objection (and can come up with some reliable refs that meet WP:MEDRS). --sciencewatcher (talk) 03:46, 12 January 2009 (UTC)

Okay here goes nothing. There are a lot of citations missing in the article but I'll start with the section I've initially called out.

The deposition hypothesis was whacked as I could not find anything appropriate. Again, here is the search query I tried: google search

The toxin theory seems a bit of a stretch, but I did find at least one journal article using google scholar search. I have added the relevant citation regarding the theory of "magnesium deficiency [admittedly not toxin-related] plus concomitant fluoride excess (MDFE) [i.e. fluoride toxicity]. I found reprints available for part I and part II.

Viral was much easier, as I have personally seen studies related to EBV and parvo in relation to FM. A pubmed search on "fibromyalgia epstein" revealed several articles. I chose one and added it to the article. HOWEVER, I think it is important to note that the abstracts I reviewed on pubmed found NO linkage to EBV or Parvo, so it may actually be more correct to remove the idea from the article unless we acknowledge that it is merely an as-yet-unproved hypothesis (hmm...is that redundant?)

Nerve protection erosion sounds more like MS, though admittedly the symptoms of both syndromes can appear similar. A pubmed search for "fibromyalgia myelin" found a single record that did indicate myelin-protective therapy is beneficial for fibromyalgia. Given the single reference, I worry about undue weight for this hypothesis but added it to the article. If other editors think there is not enough substance for it, I think it should be stricken altogether.71.203.159.204 (talk) 02:18, 14 January 2009 (UTC)

Statins

Recent paper came out looking at MSK pain with statins in the general population. I wonder if statins should be in the differential diagnosis? PMID 18575628--Doc James (talk · contribs · email) 22:12, 18 April 2009 (UTC)

World Health Organization as source

Why isn't the WHO used as a source here? There's plenty of information there. -- BRangifer (talk) 00:27, 19 April 2009 (UTC)

If you think they have good, reliable information, feel free to work it into the text. Kind regards, Guido den Broeder (talk, visit) 19:08, 31 May 2009 (UTC)

GA nomination

I'd like to note that this article was just now nominated for GA by Mikebar (talk · contribs). I have removed the nomination for reasons explained at WT:GAN#Removed a nom. Looie496 (talk) 16:39, 17 June 2009 (UTC)

I totally disagree with your actions - the article has gone through some tough revisions over the last 2 years and I honestly believed it deserved a new consideration. I think you have removed the nom for reasons not now present and I ask you to reconsider. Mikebar (talk) 18:16, 17 June 2009 (UTC)

The main reason I removed it is because the GA process requires a lot of interaction between contributors and reviewers, and it's unfair to subject contributors to that without discussion. I don't object to the nomination on the basis of article quality, I just want to be sure that there are enough people prepared to handle the necessary discussion and revisions to make a GA process useful. It's almost always a bad idea for somebody who hasn't edited an article to nominate it without discussion on the talk page, even when the article quality seems good enough. Regards, Looie496 (talk) 18:38, 17 June 2009 (UTC)

Diagram Picture

I found the diagram picture very out-of-line with other medical diagram pictures. Do we really have to see bare-breasts to describe fibromyalgia? I'm all for bare breasts, but there is a time and a place :-) — Preceding unsigned comment added by 71.196.178.38 (talk) 17:55, 25 June 2009 (UTC)

I think the Wikipedia-is-not-censored-guideline is usable here. The image is otherwise descriptive and giving a good overview. Perhaps it can be modified so that arrows or organs overlap with the most private parts if you prefer. Mikael Häggström (talk) 09:30, 5 July 2009 (UTC)