Talk:Fibromyalgia/Archive 3

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Malingering

I was very suprised, to find the 2007 review , it says 25-30% FM cases are faked by patients, that is a very high number when the disease does not have a proved cause. It can mean, the most common explaining for FM is faking, i am disturbed from that but this is a good MEDRS. RetroS1mone talk 05:57, 8 July 2009 (UTC)

Please cite page number/section from the review in question that mentions FM, and what the primary data are. The abstract says nothing about FM. —Preceding unsigned comment added by 65.124.181.3 (talk) 19:05, 8 July 2009 (UTC)

Pls read the review. Section "epdimiology" pg 649, "estimates of malingering range from 25% to 30% for fibromyalgia cases" pg 656-657 "pain (ie, lower back pain-primarily from whiplash injuries-and fibromyalgia) and mild head injury....are the most common medical illnesses feigned" You can also look at primary studies there is one from Mittenberg, they have like thousands from patients, 2002. Pls do not delete medrs and accuse editors that they are editorializing when it is right from medrs reviews. RetroS1mone talk 22:37, 8 July 2009 (UTC)

I think it is dangerous to derive such an important number from a review that was not primarily devoted to FM. This is a very tricky issue, and my impression is that just within the past couple of years there have been substantial changes in mainstream medical opinion, as a result of brain imaging studies that clearly document differences between putative FM sufferers and other people. Looie496 (talk) 01:08, 9 July 2009 (UTC)

That is right but the malingering numbers are not "real" FM sufering people, they are people that are taking advantage from the unexplained symptoms of FM to get work and financial gains. It is important, to say there is real FM and there are people that fake it, it has alot of support in literature there is malingering and the studies are not saying, all FM is fake. Most FM is real and it is only not understood right today. RetroS1mone talk 02:28, 9 July 2009 (UTC)

o i forgot, the review is about Medically Unexplained Symptoms, fibromyalgia/CFS is a most common Medically unexplained symptoms. Alot of people that get diagnose, CFS are also diagnose, FM or MCS or GWI so alot of doctors think, they are different names for same condition, a MUS review is a FM review. RetroS1mone talk 02:36, 9 July 2009 (UTC)

The medical explanation for pain in FM is a lack of dopamine as demonstrated by strong correlations between dopaminergic deficits and clinical indices of pain, including tenderpoints. Your construct of "Medically Unexplained Symptoms" is anachronistic in this context, you pontificating shit head. Go away, read the literature, and catch up with medical science. —Preceding unsigned comment added by 208.180.53.167 (talk) 06:07, 9 July 2009 (UTC)

No that is not generally accepted reviews say FM has medically unexplained symptoms, and a correlation does not say cause. Why you are being so uncivil to me? RetroS1mone talk 13:23, 9 July 2009 (UTC)

To begin with, let it be known that I am going to remove any future uncivil comments from this talk page. Continuing with meaningful discussion: there has always been a problem with this condition in that until very recently there were no concrete tests to differentiate people who claimed to have FM from other people. The result has been a very wide divergence of opinions about what fraction of cases are spurious -- some people thinking nearly all, some thinking very few. I believe that recent studies finding measurable differences have begun to clarify the picture, but I'm far from an expert in this area. It would be helpful if people who have deeper knowledge of the topic would contribute here. Unfortunately, this article's long history of tendentious editing has driven many good contributors away. Looie496 (talk) 15:50, 9 July 2009 (UTC)

While it may be ok to put a mention of malingering in the controversies section of the article, it would seem to be a WP:Weight violation putting it into the lead. As far as I'm aware, most of the major reviews don't mention malingering (correct me if I'm wrong). --sciencewatcher (talk) 15:56, 9 July 2009 (UTC)

OK i see but i think it is important, there is not a known cause that makes 25-30% of FM, it is very interesting about malingering in this MEDRS, it can go later in article. Looie i think there has been measurable difference since the sleep studies in 1975, problem is, measurable difference does not say the difference is causing the condition or the difference is unique on the condition. That is a problem alot of scientists have w FM research bc they are most doing FM against total healthy controls. I hope they can find reliable marker and diagnostic but it is not there today. I tried on adding some new MEDRS and take out nonmedrs and primary i think we can work together and make a better article. RetroS1mone talk 03:26, 10 July 2009 (UTC)

The malingering "issue" is a total noise signal. Every disorder in the world including diabetes, hypertension and cancer is affected by malingerers who feign illness for financial gain. There is nothing unique about malingering in FM per se, but to add it as content in this article only further adds to the stigmatization of the persons whose lives are destroyed by this disorder. Biologically speaking, catastrophizing is a much more pertinant issue because it has a demonstrable affect on brain function. What the last several days have demonstrated is that a self-righteous editor with an axe to grind can wreck havoc on an article by insisting on inserting some factoid that s/he "iscovered" that "proves" her point, which at a fundamental level introduces a gross amount of OPINION and EDITORIALIZING while masquereding as good faith editing. In the meantime, a great article is now in shambles. SHAME ON YOU! —Preceding unsigned comment added by 63.246.174.4 (talk) 14:02, 11 July 2009 (UTC)

That is very harsh ip, i do not have axe to grind i have a respect for medical literature. It is notable and encyclopedic when a condition is the second most malingered condition after head injury. A doctor has to make decision, do i tell patient what MEDRS says and i think, or do i reassure, and the doctor wants make the patient better so some times they think, a small not-truth is better if it helps the patient. Other doctors think, an un-truth and a label does not help the patient it hurts patient and medical profession and science and society. This debate, it does not say, all FM is malingered, i do not think that, no one think it, but some is and this is encyclopedia we write verified and MEDRS on medical articles, it is not right, censor sth bc some people think it can make some one feel bad. i am sorry RetroS1mone talk 14:16, 11 July 2009 (UTC)

It is worth recalling that "malingering" is a phenomenon which occurs in the mind of a physician who is unable to recognize an illness-- a category which once included allergies. Given that the mechanism of fibromyalgia, i.e. calcium phosphate displacing ATP in the mitochondria, has been known for at least a decade, I am surprised to learn that as many as 70 to 75% of MDs are willing to set aside their Brahminism long enough to admit that this genetic defect exists. Of course, given that Wikipedia is largely a vanity message board for Harvard alumni, and Dr. R. Paul St. Amand is not of that elite, I am far from astonished to see that his identification of it and discovery of a successful treatment are omitted from the article. I have it. It's been treated for nine years now. Guaifenesin works slowly, but nothing else works at all.66.81.219.175 (talk) 02:23, 22 July 2009 (UTC)

Do you have a reliable source for the calcium phosphate hypothesis, when you do i can put it in the article all though I am not Harvard Alumni, i was kicked out from there!! RetroS1mone talk 02:44, 22 July 2009 (UTC)

Primary sources

The article should have more good review sources, so many on FM and so many total different ideas about it, the article does not have all of them right now. Major stuff is missing like the views about sensitization and somatization and medicalization and social construction, it is all in MEDRS and it is not in article now. Now there is so much emphasizing on primary research and hypotheses and imaging studies, they are not convincing for alot from top FM experts who say a correlation it is not a prooof for cause. RetroS1mone talk 02:31, 11 July 2009 (UTC)

When I was looking at the brain imaging sections in the article I noticed most were primary studies, and I agree these should probably be replaced by reviews. Also we need to mention catastrophizing as discussed above - when I was looking at the research yesterday it appears to be an important factor in amplifying pain in fibromyalgia, but isn't mentioned in the article. Currently the article seems to be putting a slant on the research implying that the abnormalities prove that FMS is a organic disease, but if you read the reviews (and see the comment from a review I put into the lead yesterday) they say that these abnormalities are most likely the result of a stress-related illness.

And I would caution RetroS1mone to refrain from putting the MUS info into the lead. The abstract of neither of your references actually mentions fibromyalgia, and if MUS isn't mentioned in any of the major fibromyalgia reviews I don't see how it is important enough to put into the lead. --sciencewatcher (talk) 17:27, 11 July 2009 (UTC)

OK but the body of the references does say it, and FM is medically unexplained. Here is more evidence from MEDRS and some quotes from abstracts,

• Psychosomatics. 2008 Nov-Dec;49(6):470-7. "Syndromes characterized by chronic, medically unexplained fatigue, effort- and stress-intolerance, and widespread pain are highly prevalent in medicine. RESULTS: In chronic fatigue syndrome (CFS) and fibromyalgia (FM), various perpetuating factors may impair patients' quality of life and functioning and impede recovery."
• Harv Rev Psychiatry. 2008;16(1):35-54. “the authors devised an evidence-based strategy to determine the data quality in studies purporting to link IntPV and some medically unexplained disorders in women (irritable bowel syndrome, chronic pelvic pain, fibromyalgia/chronic fatigue, and other chronic pain syndromes).”
• Rheumatol Int. 2007 Sep;27(11):999-1004. "Fibromyalgia (FM) is a medically unexplained or functional somatic syndrome (FSS)."
• Smythe HA J Rheumatol 2005 Dec;32(12):2288-90 "Temporomandibular joint disorder and other medically unexplained symptoms in rheumatoid arthritis, osteoarthritis, and fibromyalgia."
• J Clin Exp Neuropsychol. 2004 May;26(3):369-92.
• Neurologist. 2004 Jan;10(1):18-30. “Evaluation and management of medically unexplained physical symptoms.” Richardson RD, Engel CC Jr. "Examples of syndromes consisting of MUPS include chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, somatoform disorders, and 'Gulf War Syndrome.’"
• Int J Methods Psychiatr Res. 2003;12(1):34-43. "Antidepressants and cognitive-behavioural therapy are both effective for treatment of somatic symptoms, as well as for functional somatic syndromes such as irritable bowel syndrome, fibromyalgia, pain disorders, and chronic headache."
• Environ Health Perspect. 2002 Aug;110 Suppl 4:607-11. "Chronic Lyme disease is the most recent in a continuing series of "medically unexplained symptoms" syndromes. These syndromes, such as fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity, meet the need for a societally and morally acceptable explanation for ill-defined symptoms in the absence of objective physical and laboratory findings."
• Baillieres Best Pract Res Clin Rheumatol. 1999 Sep;13(3):427-36. "Most medical specialities have defined medically unexplained syndromes such as fibromyalgia, to categorize patients with prominent but unexplained symptoms. Other such syndromes include irritable bowel syndrome, chronic fatigue syndrome and atypical chest pain."

Is that enough to say MUS? RetroS1mone talk 04:34, 13 July 2009 (UTC)

Edit warring

I have protected the page due to the content dispute that has taken over the recent page history. Please discuss your issues here and come to a consensus as to the best way forward under our policies and guidelines. Please also read WP:3RR, both editors were 1 revert away from a block. Regards, Woody (talk) 22:58, 11 July 2009 (UTC)

Not connected to the dispute, but under the heading "Diagnosis" I think it would be useful and correct to wikilink arthritis and osteoporosis. --Derek Andrews (talk) 23:57, 11 July 2009 (UTC)

Comorbidity and diagnosis

This review PMID 17602995 states that 20-30% of people with rheumatoid arthritis and systemic lupus erythematosus also have fibromyalgia. - Tekaphor (TALK) 10:27, 13 July 2009 (UTC)

There is also a high co-morbidity (as high as 90%) in FMS patients with Neurally Mediated Hypotension, which perhaps deserves a mention on the page. —Preceding unsigned comment added by 24.20.109.221 (talk) 11:32, 6 August 2009 (UTC)

MUPS

I think Robinhood70's comment also applies here. There is insufficient evidence that the term MUS or MUPS is frequently associated with Fibromyalgia, and it is up to RetroS1mone to provide evidence that it is (neither of the 3 refs do this). --sciencewatcher (talk) 14:58, 19 July 2009 (UTC)

I gave evidence above, I give MEDRS reviews, you do not comment on any, you just say you can not read them and sth is not in abstract when it is. RetroS1mone talk 23:42, 19 July 2009 (UTC)

All 3 refs say it Sciencewatcher, do you want quotes, pls ask and i will send, MEDRS does not say it needs be in abstract or it needs be in every big review you have in your personal collection, sorry but it is getting wierd how i give 3 references thene 9 references then 20 references and people keep saying, no evidence. May be we need dispute resolution?? here is more

• Meta analytic review pmid12883101 of 244 MUPS (medically unexplained physical symptoms) studies, including "four functional somatic syndromes for which there were sufficient numbers for meta-analytic integration: irritable bowel syndrome (IBS), nonulcer dyspepsia (NUD), fibromyalgia (FM), and chronic fatigue syndrome (CFS)." and "Meta-analytic integration confirms that the four functional somatic syndromes (IBS, NUD, FM, CFS) are related to (but not fully dependent on) depression and anxiety. Sciencewatcher says the references i give do not have enough citations, this has 193 citations.

• pmid14694702 "To overcome the confusion around the term ‘somatisation’, many researchers prefer the term ‘medically unexplained symptoms (MUPS)’" Figure 1 shows CFS as one of five functional symptom groupings and CFS is also in the text. 59 citations

• pmid12194900 Abstract "Medically unexplained physical symptoms (MUPS) are persistent idiopathic symptoms that drive patients to seek medical care. MUPS syndromes include chronic fatigue syndrome, fibromyalgia syndrome, and multiple chemical sensitivities" 36 citations

• The Neurologist, Evaluation and Management of Medically Unexplained Physical Symptoms Richardson, Ralph D. PhD; Engel, Charles C. Jr. MD, MPH "Examples of syndromes consisting of MUPS include chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, somatoform disorders, ..."

Textbooks

• Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry Benjamin J. Sadock, Harold I. Kaplan, Virginia A. Sadock Edition 10 Lippincott Williams & Wilkins, 2007 ISBN 078177327X
• Encyclopedia of cognitive behavior therapy Arthur Freeman, Stéphanie H. Felgoise, Arthur M. Nezu, Christine M. Nezu Taylor & Francis US, 2005 ISBN 030648580X It has a chapter called "Medically Unexplained Symptoms" with different sections for Chronic fatigue syndrome, Fibromyalgia, and Noncardiac Chest Pain. p 241-44
• Understanding Somatization in the Practice of Clinical Neuropsychology Greg J. Lamberty, American Academy of Clinical Neuropsychology, Oxford University Press US, 2007 ISBN 0195328272

Lots of evidence for use of term in fibromyalgia, it should be in article, when you do not want in lead lets discuss that but i think it should be in article also when it is not "politically correct" for some people. RetroS1mone talk 00:02, 20 July 2009 (UTC)

Certainly, there are MEDRS references linking fibromyalgia and MUPS. However there are no fibromyalgia articles that even mention MUPS or "medically unexplained". Try searching on google scholar for articles with fibromyalgia in the title and either "mups" or "medically unexplained" anywhere in the article. You will find only about 5 results, all with 1 or less citations. Do the same search for "pain" and the first result has hundreds of citations. Conclusion: fibromyalgia research generally doesn't mention MUPS or "medically unexplained". --sciencewatcher (talk) 02:40, 20 July 2009 (UTC)

I want to make people aware that this MUPS thing is spilling over into other articles as well.[1][2] Ward20 (talk) 03:30, 20 July 2009 (UTC)

Sciencewatcher pls confirm for me these are "no fibromyalgia articles" bc they all say MUPS or MUS or medically unexplained so i am confused,

• a 2008 review called "Customizing treatment of chronic fatigue syndrome and fibromyalgia: the role of perpetuating factors."
• A 2008 article called "Attitudes towards fibromyalgia: a survey of Canadian chiropractic, naturopathic, physical therapy and occupational therapy students." from a group called "the Medically Unexplained Syndromes Study Group"
• A 2008 literature review by one of most famous FM researchers, Yunus, called "Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness."
• A 2007 review called "Fibromyalgia: a rheumatologic diagnosis?" in one of main journals where they publish on FM
• "Creating meaning in fibromyalgia syndrome."
• A 2005 review called "Temporomandibular joint disorder and other medically unexplained symptoms in rheumatoid arthritis, osteoarthritis, and fibromyalgia."
• A 2005 study of 180 patients called "Co-morbidity and physician use in fibromyalgia."
• A 2004 study of 1312 people called "Comorbidity of fibromyalgia and posttraumatic stress disorder symptoms in a community sample of women."
• article called "Restricted emotional processing and somatic attribution in fibromyalgia."
• article called "Attributions in chronic fatigue syndrome and fibromyalgia syndrome in tertiary care."
• 1999 review called "Is fibromyalgia a distinct clinical entity? Historical and epidemiological evidence."

There is more MEDRS evidence, FM is a medically unexplained syndrome, then MEDRS for 75% from stuff in this article. Pls explain me, when article on fibromyalgia with fibromyalgia in title is not article on fibromyalgia and when MEDRS is not MEDRS. Thx RetroS1mone talk 11:09, 20 July 2009 (UTC)

Oops, my fault. I discovered google scholar can't actually do the search I thought I was doing on it. It looks like you have built a pretty good case for including "medically unexplained" in the article after all. --sciencewatcher (talk) 14:10, 20 July 2009 (UTC)

HELP REQUESTED

I hope to go live with User:MichaelQSchmidt/sandbox/National Fibromyalgia Association within the next day or so. If anyone can expand a section, add a source, or corect a typo... please help out. Thanks, MichaelQSchmidt (talk) 22:50, 19 July 2009 (UTC)

Thx MQS i made comments on your talk page and i added some references. RetroS1mone talk 00:02, 20 July 2009 (UTC)

Great, and thanks. All help is appreciated. I agree that giving a bit of background on the founders is a terrific idea. MichaelQSchmidt (talk) 01:36, 20 July 2009 (UTC)

Edit warring

This is a very conteroversial article BC the subject is also very conteroversial, that is why there needs be MEDRS followed on this article and it needs show different view points from different doctors. It does not mean, i want to "intent to trash the basis for which many people are suffering." like User:WebHamster accuses me at his talk page User_talk:WebHamster#Concern. When people are not liking words, pls discuss it like Sciencewatcher and me discussed MUS up there and it find out I made the case and convinced Sciencewatcher and also people at MEDRS talk page Wikipedia_talk:Reliable_sources_(medicine-related_articles)#Medically_unexplained_symptoms. Pls do not delete MEDRS, pls discuss on talk page. Thx RetroS1mone talk 02:06, 21 July 2009 (UTC)

I put back in MEDRS that IP address and WebHamster deleted wo discussing. The MUS is discussed here and at MEDRS. The malingering section i moved to bottom of section wo it's own title under "other" bc malingering is not a cause of actual FM it is a cause of some reported cases. And malingering literature says, FM is a common malingered condition. It does not mean all FM is malingered, i do not htink all FM is malingered, no person says all FM is malingered but it is a common malingered condition from MEDRS. Other deleted things, they all had sources, MEDRS reviews. I am very happy, talking about where to put things and how say it, but pls do not delete MEDRS wo discussing. Thx RetroS1mone talk 02:13, 21 July 2009 (UTC)

The references aren't the problem. It's your prose that is the problem and the way you use the references as if they are the absolute truth rather than just a set of opinions. FM isn't diagnosed or officially classified on the basis that it is a MUPS, it is just believed to be by some researchers. I don't deny that the references should be a part of the article as they should be in there somewhere, just not in the lede and certainly not accompanied by your POV text. --WebHamster 09:10, 21 July 2009 (UTC)

OK pls give alternative text do not delete MEDRS. RetroS1mone talk 12:09, 21 July 2009 (UTC)

WebHamster i think it is misunderstanding what "MUS" is, FM is not "a MUPS" i do not say it, no person says it. The sources say, the symptoms in the FM syndrome are medically unexplained. OK, some people believe FM is caused by one or another thing, but there is no consensus the consensus is, FM as syndrome and the symptoms in the syndrome do not have known etiology, so they are MUS. RetroS1mone talk 12:26, 21 July 2009 (UTC)

Actually, fibromyalgia is not a syndrome per se. Fibromyalgia Syndrome is a syndrome. The primary document for the classification of fibromyalgia upon wch the de facto diagnostic criteria are derived states there are two defining criteria, i.e. chronic widespread pain and pain on palpation. The comorbid symptoms that characterize the syndrome are not part of the classification of FM per se. Perhaps you should consider starting a new WP article on FM syndrome where you would be able to input all your pseudo-editorial dross and take all your asinine MUPS/MUS crusading with you. 71.212.10.108 (talk) 14:01, 21 July 2009 (UTC)

I will reiterate as you seem to have either not understood what I wrote or because you ignored it. The references aren't the problem. It's how you are using them that's the problem. --WebHamster 14:17, 21 July 2009 (UTC)

Physical Treatment

Physical treatments have been shown to be effective on some of the population sometimes, but very hard to predict because everyone that "has" fibromyalgia tend to be so different in their symptom levels and other causative factors. No matter what the treatment (physical therapy, massage, chiro manipulation, osteo manipulation, etc) everyone tends to respond differently to treatment.

As a side note removal of the chiropractic mention should be done. The referenced article is a very bias and missed referenced itself. There are much better ones out there and until one is put up, there should be no mention. Partially due to the fact the "chiropractic" is such a broad definition. It does encompass much more that just manipulation, just like physical therapy —Preceding unsigned comment added by 74.216.56.121 (talk) 17:15, 13 August 2009 (UTC)

Lead Section editing

I've just been working with what was there so doubtless it could be much improved. Main focus of work was wiki-ing and minor grammer changes to ease reading. I didn't remove any material although I did go back to the sources for some rephrasing and I shuffled the material around so there's a thematic progression: first para definition, second para spread, prognosis and treatment, 3rd para current status as medically unexplained. Could do with some more references... specifically there are references for effectiveness of psychological and exercise therapies. I'd like to see refs available for effectiveness of medications and patient education too. I expect there's a whole bunch of different estimates of the percentage of people with FM - I just went with the source there in the lead but I hope others will be cited too. I used the quote from Buskilla and Cohen as the phrase "many people with FM" is very subjective... the quote's somewhat subjective too so it might be better to quote the actual statistics from the quoted research article. I'd also like to see a reference available for how some doctors see FM as a non-disease becauce of lack of abnormalities on observation since the lack of it contrasts poorly with the ones we already have for lack of diagnostic tests and overlapping of proposed conditions. --Dakinijones (talk) 11:15, 2 October 2009 (UTC)

Retrovirus Research

I noticed that no one has mentioned the new research done here: http://kaessa.com/2009/10/fibromyalgia-caused-by-a-retrovirus/

It shows a >95% correlation with chronic fatigue and fibromyalgia sufferers, and I think it pushes the "is it real" debate strongly in one direction. 206.145.28.20 (talk) 14:26, 15 October 2009 (UTC)

This is now covered in the CFS article and has been extensively discussed on the CFS talk page. The original Science paper was framed in terms of CFS rather than fibromyalgia, so there are issues about whether it should be covered in this article at this point. Looie496 (talk) 15:45, 15 October 2009 (UTC)

Archiving

The talk page and first archive seemed to overlap a bit in terms of dates, I suspect due to the old Talk page structure proposal which advocated a non-standard approach. That proposal, from 2007, was still on this talk page, but meanwhile, at least one comment from November 2008 was archived while comments from October 2008 were not. Rather than try to sort it all out, I simply bulk-copied all topics up to the end of June 2009 into Archive 2. Hopefully this will make this page a little easier to navigate and we can follow normal archiving patterns from now on. —RobinHood70 ^{(talk • contribs)} 22:58, 13 December 2009 (UTC)

More recent reviews of cognitive correlates

You might consider replacing

• Glass JM. (2006). "Cognitive dysfunction in fibromyalgia and chronic fatigue syndrome: new trends and future directions". Curr Rheumatol Rep. 8 (6): 425–9. doi:10.1007/s11926-006-0036-0. PMID 17092441. {{cite journal}}: Unknown parameter |month= ignored (help)
  

with one or both of these. I can't access either to compare them.

• Glass, J.M. (2008). "Fibromyalgia and cognition". Journal of clinical psychiatry. 69 (Suppl. 2): 20–4. PMID 18537459.
• Glass, J.M. (2009). "Review of cognitive dysfunction in fibromyalgia: a convergence on working memory and attentional control impairments". Rheumatic disease clinics of North America. 35 (2): 299–311. PMID 19647144.

Anthony (talk) 09:37, 30 December 2009 (UTC)

About to go live

Last minute input is requested for User:MichaelQSchmidt/sandbox/National Fibromyalgia Association. Thank you, MichaelQSchmidt (talk) — Preceding undated comment added 07:43, 20 July 2009 (UTC)

Lead

Some time ago, the Medically unexplained physical symptoms article was spammed into any number of articles by an editor with a fairly demonstrable pro-psychological bent. Today, I decided to have a look around and see what was left and if it made sense. Clearly, in this article, it does make sense in some places, as demonstrated in the MUPS discussion, but I'm concerned about the last paragraph in the lead. I think it would be very educational to look at how the entire context of the lead has changed, particularly in terms of the fact that it now closes leaving you with the impression that researchers are leaning heavily towards a psychological causation which, as far as I know, is not the case. (This is not to say that this isn't possible, just that it's still very much up in the air.) Anyway, compare the following two paragraphs, the first from July 5, the second as of today:

Fibromyalgia is considered a controversial diagnosis, with some authors contending that the disorder is a ‘non-disease’, due in part to a lack of abnormalities on physical examination, objective laboratory tests or medical imaging studies to confirm the diagnosis. While historically considered either a musculoskeletal disease or neuropsychiatric condition, evidence from research conducted in the last three decades has revealed abnormalities within the central nervous system affecting brain regions that may be linked both to clinical symptoms and research phenomena. Although there is as yet no generally accepted cure for fibromyalgia, there are treatments that have been demonstrated by controlled clinical trials to be effective in reducing symptoms, including medications, patient education, exercise, and behavioral interventions.

vs.

As a currently medically unexplained syndrome, lacking scientific consensus as to its cause or causes, fibromyalgia is a controversial diagnosis. Many members of the medical community consider fibromyalgia a "non-disease" because of a lack of abnormalities on physical examination, the absence of objective diagnostic tests, and extensive overlap with other proposed conditions such as chronic fatigue syndrome and multiple chemical sensitivity. Although several brain imaging studies have shown evidence for possible neurological differences in fibromyalgia and healthy controls, these studies may show only correlation, not causation, and fibromyalgia might be the result of childhood stress or prolonged or severe stress rather than a primary disorder of the brain.

The first clearly leans in favour of a biological basis to the disease while the second leans just as clearly towards a psychological causation, all but outright dismissing its own statement about brain imaging studies. I also don't feel the link to MUPS is warranted in the lead, both because of its awkwardness and the possible bias it lends, though I'm fine with the other two links in the article where they are. I would instead suggest something like the following (with appropriate links and references added back in in the final product):

Fibromyalgia is considered a controversial diagnosis, lacking scientific consensus as to its cause or causes. Many members of the medical community consider fibromyalgia a "non-disease" because of a lack of abnormalities on physical examination, the absence of objective diagnostic tests, and extensive overlap with other proposed conditions such as chronic fatigue syndrome and multiple chemical sensitivity. While historically considered either a musculoskeletal disease or neuropsychiatric condition, evidence from research conducted in the last three decades has revealed abnormalities within the central nervous system affecting brain regions that may be linked both to clinical symptoms and research phenomena. It should be noted, however, that these studies show only correlation, not causation, and some research suggests that fibromyalgia might be the result of childhood stress, or prolonged or severe stress. Although there is as yet no generally accepted cure for fibromyalgia, some treatments have been demonstrated by controlled clinical trials to be effective in reducing symptoms, including medications, behavioral interventions, patient education, and exercise.

As written, this would require a little re-touching of the previous paragraphs in the current lead, since the last sentence incorporates most of the paragraph before it.

Thoughts? —RobinHood70 ^{(talk • contribs)} 22:37, 13 December 2009 (UTC)

Agree, especially because of the nature of MUPS. After reading studies mentioning the term, it seems to me the word is not widespread or consistently agreed upon within the medical community. Ward20 (talk) 07:00, 14 December 2009 (UTC)

Okay, in the absence of any further feedback, I've made the changes discussed above. It may still need some minor touch-ups, but I'll let those of you more familiar with the article figure that part out. —RobinHood70 ^{(talk • contribs)} 18:33, 20 December 2009 (UTC)

Why use the words "non-disease" at all? Just say they don't believe that it's a disease. - Tbsdy lives (formerly Ta bu shi da yu) ^talk 12:43, 8 January 2010 (UTC)

Taking out the "non disease" comment

There is no valid reason for it to say that "mamy" view Fibro as a "non-disease." It is already listed as such at the end of the article. —Preceding unsigned comment added by 70.57.228.12 (talk) 04:05, 7 January 2010 (UTC)

You removed considerably more than just the mention of it sometimes being viewed as a "non-disease." I disagree with the removal of the mention, as the leed section is intended to summarize the rest of the article, including controversies. --- Barek (talk • contribs) - 04:33, 7 January 2010 (UTC)

It has already been stated above that the two references in the removed section are not actual references to the statements listed. It does not summarize the article to list the controversies at the begining of the article. I think you just have something against people with Fibromyalgia, honestly. —Preceding unsigned comment added by 70.57.228.12 (talk) 04:54, 7 January 2010 (UTC)

(ec)I suggest you review WP:AGF. If controversies are contained in an article, then it stands to reason that summarizing the article would also mention that controversies exist. --- Barek (talk • contribs) - 04:58, 7 January 2010 (UTC)

We need to discuss this more it can be removed or left, so I reverted the removal edit that was just made. --Maximz2005 ^(Talk) 04:57, 7 January 2010 (UTC)

Note: the specific section was recently discussed (above) and changed to its current wording per Talk:Fibromyalgia#Lead. --- Barek (talk • contribs) - 05:02, 7 January 2010 (UTC)

I see. User:70.57.228.12, please stop removing the content in question and reverting our reverts of your removal. If you disagree with the conclusion of the previously held discussion on this issue, please add a notice there so that this can be resolved diplomatically. If you continue such actions on this page, I will have to submit a request for administrator input on this. Thank you. --Maximz2005 ^(Talk) 05:10, 7 January 2010 (UTC)

I would love admistrator input on this. The summary on Metallica does not mention that there are people who are not believers in Metallica. There is no reason for it to list the controversy twice. There are other points in the article that merit summarization. Plus the two references do not support the statements. Someone who does not believe in Fibromyalgia--while i sit here with the actual disease, diagnosed by the Cleveland Clinic based on the the criteria for Fibromyalgia--is responsible for the misinformation. I would love for a moderator to to review the two references and to finally remove that chunk of ridiculous speculation from this article. —Preceding unsigned comment added by 70.57.228.12 (talk) 06:05, 7 January 2010 (UTC)

Per WP:LEAD, "The lead should establish significance, include mention of notable criticism or controversies ..." --- Barek (talk • contribs) - 06:19, 7 January 2010 (UTC)

Bottom line: The two citations do not support the fact stated in the lead. Those are subjective opinins and are not viewed as facts by the medical community. The real controversy would be that the FDA approved medication for something that is considered a "non-disease." You do not own this article and have no right to insert your opinions with invalid citations. —Preceding unsigned comment added by 70.57.228.12 (talk) 06:23, 7 January 2010 (UTC)

The actual bottom line is that Wikipedia works based on community consensus. Multiple editors have discussed the lead (here and in earlier threads). The cited sources adequately demonstrate that controversy exists.

More troubling, in order to remove the mention, you wipe out an entire paragraph that covers more than just what you are claiming to be removing. Per WP:LEAD, the mention of notable controversies, if existing in the article, should be mentioned in the lead.

Lastly, you are now in violation of WP:3RR, despite warning both above and on your user talk page. --- Barek (talk • contribs) - 06:29, 7 January 2010 (UTC)

Funyy how you skirt the issue that there are no valid cited sources that say this, anywhere. I don't care what you think. This article sources info that is two decades old and Fibromyalgia in NOT considered a NON diesease. I see plenty of people who disagree with you that are being ingnored. It seems to me that the community concesus does not just equal your opnion. AND YOU ARE STATING OPINION as your two citations are completely invalid. —Preceding unsigned comment added by 70.57.228.12 (talk) 06:33, 7 January 2010 (UTC)

First, they are not "my" sources, I did not add them. Second, the sources do establish that there are critics who call it a "non-disease" - they don't call it such themselves, but it is specifically stated that it is what critics have called it. Third, you are pointing to one post by one person above; I am pointing to posts by multiple persons.

If you have a problem with the controversy section, start a discussion about it. But as it exists, WP:LEAD is clear that notable controversies should be summarized in the lead.

Also, as has been pointed out, you are wiping out a full paragraph which only has the first couple of sentences touch on the controversy - you fail to provide reasons for wiping out the rest of the paragraph. Additionally, your edit then results in a broken ref tag in the references section showing in bold red "Cite error: Invalid <ref> tag; no text was provided for refs named p18270311; see Help:Cite error." which is a direct result of your wholesale blanking of the paragraph. --- Barek (talk • contribs) - 06:47, 7 January 2010 (UTC)

And you are edit warring, so you're just about to get blocked from Wikipedia. The way to do this right is to discuss, not attempt to force your version on the world, which only lasts for a few minutes or seconds. Real change here only occurs by following the sources, including sourced opinions. Note that contradictory information is included because Wikipedia mirrors what's happening in the world. We don't write sales brochures here. -- Brangifer (talk) 06:49, 7 January 2010 (UTC)

My version of Fibromyalgia is based on scientific fact. There is NO verifiable source for the "non disease" citation. LOL there are like 10 ways to work around being blocked on Wiki. —Preceding unsigned comment added by 97.115.198.139 (talk) 07:15, 7 January 2010 (UTC)

Luckily there are more than 10 admins, and we can semi-protect the article (which we've done), so this threat, aside from locking down the article from your friends, is rather an empty threat. - Tbsdy lives (formerly Ta bu shi da yu) ^talk 12:42, 8 January 2010 (UTC)

A simple change to wording should really suffice here. There's really no need for scare quotes. - Tbsdy lives (formerly Ta bu shi da yu) ^talk 12:41, 8 January 2010 (UTC)

Request semi-protection

Please protect this article from persistent vandalism and block the current vandal for edit warring. -- Brangifer (talk) 07:22, 7 January 2010 (UTC) Please remove the second section of the lead. It cites invalid citations. The statement in the lead regarding Fibromyalgia being a "non disease" is not a fact. I am trying to remove inacuracies from the article. I am being called a "vandal" for restoring this article to valid, verifiable facts. There has been much discussion above abhout this topic. The general concesus is that the "non disease" comment is factually inacurate but people keep re-inserting it into the article. The two citations are false. —Preceding unsigned comment added by 97.115.198.139 (talk) 07:30, 7 January 2010 (UTC)

To request protection, please ask at WP:RFPP. To report edit warring, please go to WP:AN/EW. It appears that the 3RR violating IP has been blocked. Also, this looks like a content dispute to me and not vandalism. Timotheus Canens (talk) 11:13, 7 January 2010 (UTC)

In my opnion this is a content dispute. Inserting personal opinions based on fictitious citations while ignoring the groups wishes is the only vandalism that has occurred here. The person who keeps re-inserting the deleted text fails to see that the whole paragraph seems to deny the existance of a disease that there are now FDA approved medications to treat said illness. The supposition that Fibromyalgia does not exist or is a "non disease" is an attitude that died out several years ago. There quantifiable symptoms to this illness. It is absolutely NOT the presence of no other illness. While the arguements for Fibro are detailed, and full of documented evidence the "controversy" is full of speculations and attitudes that deed out 5 years ago. The rest of the lead was dedicated to the reasons that Fibro does not exist, or is psychological--which is just considered ignorant these days. There is already a controversy section full of ignorance, and loosely cited studies taken out fo context. The only people who deny the existance of Fibromyalgia are people who seek to gain from denying the pain and suffering from real people that have it. The user who insists that this info must be included obviously has a personal stake in this illness' statud remaining ambiguous. I look through the comments and I see a general agreement that the "non-disease" comment should come out. I see one or two users who are manipulating the decision of the group and ignoring the fact that the group has already determined thier opnion on the secind half of the lead. The only user here who is defending that is remains in is obviously the person who inserted it. He/she has taken no steps to defend the fact that thier content is manufactured, and taken out fo context. You can block whomever you want but I can bring back the whole entire Fibromyalgia Sufferers Group from Facebook and we can see how 80,000 people feel about that invalid comment. —Preceding unsigned comment added by 174.30.135.4 (talk) 14:09, 7 January 2010 (UTC)

• NOTE -- The page has been temporarily semi-protected in order to limit the current edit warring. Please discuss any dispute about content and references on the talk page here first. Thank you. — CactusWriter | ^needles 15:17, 7 January 2010 (UTC)

The anon seems to be addressing me in his/her claims, so I'll reply as such. First, I would like to point out that multiple other established users have restored the material - it's not just me. Also, the idea that I added the material initially is demonstrably absurd - look at my edit history, and look at the article's edit history - 'nuff said. Next, I have responded to your claims about the sources, I won't repeat it again here. In line with that, please keep discussions to current threads. The addition of new comments into months old discussions above to give the impression that earlier discussions disputed keeping the mention is misleading (talk page edit history shows the edits).

Lastly, the idea that it is not real has regrettably not died out, not all doctors recognize it. I have recent family experience with the need to change physicians because the first would diagnose it as anything but fibromyalgia and dismissing it when suggested. After dragging on this way and being concerned with potential suicide, a new doctor diagnosed it relatively quickly and with treatment has reduced the severity of the pain. I cannot use this as a source, as it's personal experience, but I hope it helps clear up some misinformation being suggested about my motivations.

Readers deserve to know that there is controversy, and that Fibromyalgia is not universally recognized. The wording may need to be improved, in fact I'm certain that it does (for one, I would say replace "many" with "some" or otherwise express that there are exceptions to acceptance in a way that does not imply that a large majority in the medical field dispute it); but if a reader is not aware that controversy exists, they may accept the diagnoses of the first physician and stay with a physician that does not accept it as a medical condition. Doing so can slow getting a real diagnosis that then results in delayed treatment. --- Barek (talk • contribs) - 16:04, 7 January 2010 (UTC)

so, you feel you can just make a story, and fictitious citations and everyone should belive you? the reason that wikipedia has no credibility on this earth, in addition to the reasopn that this article is rated b- —Preceding unsigned comment added by 174.30.135.4 (talk • contribs) 09:13, 8 January 2010

Please direct your comments to the article text and not the editors. There are obviously strong emotions involved here, but it is always best to work through these discussions with a civil spirit. (Therefore, I refactored your comment to remove the personal attack)

Because the controversy and citations are factual, and it has played a significant role in the history of Fibromyalgia, the lede information cannot be simply deleted en masse. However, the specific wording can be tweaked to more accurately portray the controversy. I am not very familiar with the entire history, but my reading of the sources suggests changing the term "non-disease" with the the term non-specific disorder. For me, that most accurately reflects the extent of the Goldenberg citation. — CactusWriter | ^needles 11:59, 8 January 2010 (UTC)

As I mentioned above, I agree that the wording needs to be improved. Rephrasing of the term "non-disease" is a good step, but the section does seem to over-emphasize the controversy and could be toned down further, while still retaining some mention for accuracy. --- Barek (talk • contribs) - 05:17, 9 January 2010 (UTC)

I'm a lurker here, but can I suggest including a mention of this or a clearer statement of the author's position. The author argues FMS's etiology may lie in constant (tonic) deep nociceptive pain. Including this peripheral physiological explanation alongside Goldenberg Wolfe would further emphasize that "correlation is not causation" regarding neurological evidence, and remove the appearance of bias toward the psychological explanation. Anthony (talk) 16:45, 9 January 2010 (UTC) How about:

...some research suggests that fibromyalgia is the result of childhood stress, or prolonged or severe stress, while other research suggests fibromyalgia syndrome is the product of ongoing deep physical pain, originating in muscles, tendons, viscera, etc. Anthony (talk) 17:34, 9 January 2010 (UTC)

I have inserted the above, but really think this discussion belongs in the body of the text, and the lead should simply mention the etiology is unknown, though there are diverse worthy theories, and there is no known cure, though some treatments show promise for some patients. Anthony 16:34, 10 January 2010 (UTC)

Yes, the lead should summarise the main text, so you really need to add this to the main text and just put a shorter summary in the lead. Or you can just put it in the main text and not in the lead. Basically anything mentioned in the lead needs to be mentioned in the main article, but not necessarily vice-versa. --sciencewatcher (talk) 03:23, 11 January 2010 (UTC)

Good point. When I have time I'll try to fit it into the main text. Anthony 05:47, 11 January 2010 (UTC)

image balance quibble

I feel the need to point out that all the images on this page are images of women, which tends to give the impression that the disease only affects females. I don't know anything about the disease, so I cannot say whether that is true or false, but it is not mentioned in the article itself. could one of the images be replaced with a male model, or could some discussion of gender distributions be added to the article? --Ludwigs2 20:45, 28 January 2010 (UTC)

I don't remember the numbers, but it very rarely affects men. In my over 20 years as a PT and PA, I have only encountered a couple men with it, but hundreds of women. The anatomical distribution is identical. -- Brangifer (talk) 05:04, 29 January 2010 (UTC)

oh, ok. let me see if I can dig up some gender-distribution figures to use in the article, then. if that's true, it's a useful and important bit of information. --Ludwigs2 05:41, 29 January 2010 (UTC)

Google: fibromyalgia gender. A start. -- Brangifer (talk) 07:56, 29 January 2010 (UTC)

Causation - missing details?

Without any intention of weasel word use, I've seen many articles on FM - and heard a lot from my pain management doctor, as I have a diagnosis of it myself - that cite spinal trauma as a possible cause/trigger factor for FMS. (In my own case, they have said it's highly likely, as I sustained damage to nerves in the region of my lumbar spine several years ago and have never been out of pain since.

My question being - is there a reason that this isn't included in the article?

80.7.115.149 (talk) 20:47, 14 July 2009 (UTC)Trialia

The reason is simply that nobody has put it in the article yet! I did a few searches, and there seem to be good references supporting this. Ideally you'd want a well-cited review. Maybe look through the current reviews in the article (Goldenberg, and others) and see what they say about spinal injuries and FMS. I also thought car accidents were a trigger, but it isn't mentioned either in the current article. --sciencewatcher (talk) 21:36, 14 July 2009 (UTC)

There is a full paragraph in the introduction that is entirely wrong and should be removed. Whoever added it pulled from an antiquated source and was ignorant to current medical developments in fibromyalgia. This incorrect information is the type of thing that causes the prejudice and mistreatment fibromyalgia sufferers still have to deal with. Please remove this paragraph immediately: "Fibromyalgia is considered a controversial diagnosis, lacking scientific consensus as to its cause.[11] Many members of the medical community do not consider fibromyalgia a disease because of a lack of abnormalities on physical examination and the absence of objective diagnostic tests.[11][12]" On the contrary, scientific research has discovered several physical symptoms of fibromyalgia. The wikipedia article even refers to some, later in the article, such as reduced blood flow to the thalamus. The fact is that all physical manifestations of fibromyalgia are in the brain. This includes a shrunken hippocampus among other things. These findings are only a few years old, because modern science has only recently allowed images to be taken of the brain. Fibromyalgia sufferers have suffered horribly moreso for decades because the physical impairment is in the brain, not the muscles. Please take out that paragraph so more people are not wrongly educated to distrust fibromyalgia sufferers! —Preceding unsigned comment added by AnimaStellarum (talk • contribs) 07:37, 23 April 2010 (UTC)

That statement is correct - that view is held by a large number of people in the medical community. I think you need to do a bit more research - you will find that those brain symptoms are also present in psychiatric illnesses such as depression. Just because an illness is psychiatric does not mean you should be prejudiced against it. --sciencewatcher (talk) 14:26, 23 April 2010 (UTC)

Cymbalta - Fibromyalgia

Cymbalta had no effect on pain in 50 of my fibromyalgia patients, consecutively treated. /Birger Fagher MD PhD, Lund University Sweden —Preceding unsigned comment added by 82.197.231.7 (talk) 16:43, 5 March 2010 (UTC)

I have removed Cymbalta from the article, and it should stay out until someone can provide a review supporting it. Anthony (talk) 10:04, 19 May 2010 (UTC)

I added the ref for this. Regarding Dr Fagher's comments: were the patients male or female? The clinical trial found that Cymbalta only worked for women. I'm always slightly suspicious of clinical trials paid for by the drug manufacturer. It would be good to see an independent study. --sciencewatcher (talk) 14:44, 19 May 2010 (UTC)

Neutrality & Balance

I've added a neutrality label on this article, as it is totally biased in favour of the existence of this disputed condition, with no mention at all in the article itself of the long-standing professional and academic debates about whether it exists, or is a manifestation of other conditions (osteo-arthritis, depression etc.). I'm not saying that those explanations are necessarily correct, merely that a new reader, researching the condition and coming to this page would be led to believe that this was a fully established condition without any significant disputes. Yes, those issues have been extensively aired in this talk page, but have been totally whitewashed out of the main article - an unacceptable and baiased POV. 89.241.183.8 (talk) 21:46, 4 September 2008 (UTC)

I support the neutrality tag as the article stands now and I'd like to see the article changed to reflect the controversy over this diagnosis as reported by reliable sources. Dlabtot (talk) 03:35, 5 September 2008 (UTC)

I support the neutrality tag. Actually, I'd support a passing comparison to Morgellons; the main difference is in how quickly the mainstream medical community reacted to the Morgellons mania and how it fed the fibromyalgia craze. When psychotherapy is the best treatment for a supposedly physical condition, you're in trouble. --Dnavarro (talk) 01:31, 2 June 2010 (UTC)

WTF? Can't you people read what is written in the pathophysiology section?! These are objective abnormalities that have been published in peer-reviewed journals. Catch up with history, for chrissakes! —Preceding unsigned comment added by 96.241.94.251 (talk) 14:06, 6 September 2008 (UTC)

Actually, there is a "Controversies" section at the end of the article that acknowledges this issue. Oddly, there is not one for asthma, I notice, which was until very recently considered a mental disorder/neuoroticism (see references, below). I imagine we will all look back someday and say "Gee, remember when fibromyalgia was considered controversial? How quaint!"

1: Thorén R. Psychosomatic approach to bronchial asthma. A study of 50 adult asthmatics. Acta Allergol. 1967;22(2):145-73.

2: Meyer AE, Golle R, Weitemeyer W. Duration of illness and elevation of neuroticism scores. A psychometric correlation study of males with bronchial asthma, pulmonary tuberculosis or cardiac valve lesions. J Psychosom Res. 1968 Mar;11(4):347-55.

3: Aitken RC, Zealley AK, Rosenthal SV. Psychological and physiological measures of emotion in chronic asthmatic patients. J Psychosom Res. 1969 Sep;13(3):289-97.

4: Clark TJ, Cochrane GM. Effect of personality on alveolar ventilation in patients with chronic airways obstruction. Br Med J. 1970 Jan 31;1(5691):273-5.

5: Zealley AK, Aitken RC, Rosenthal SV. Psychopathology in bronchial asthmatic patients. Scott Med J. 1970 Mar;15(3):102-7.

6: Aitken RC, Zealley AK, Barrow CG. The treatment of psychopathology in bronchial asthmatics. Ciba Found Symp. 1972;8:375-80.

7: Zealley AK, Aitken RC, Rosenthal SV. Personality and bronchial asthma. Proc R Soc Med. 1971 Aug;64(8):825-9.

&c.

--Dr. Anymouse (talk) 15:07, 8 September 2008 (UTC)

If you think improvements are needed at the asthma article, I encourage you to go ahead and make them. The 'Controversies' section hidden at the bottom of this article might as well be deleted, since it does nothing to actually describe the controversial nature of this diagnosis, rather, it spits out a huge amount of gobbledygook and jargon in what appears to be an attempt to obscure the controversial nature of this diagnosis. Dlabtot (talk) 23:34, 9 September 2008 (UTC)

Be bold? Great idea: why don't you lead the charge by offering an intelligent critique of the neuroimaging studies that distinguish persons with the disorder from healthy controls. You could start with an account of how it is that individuals who have a significantly reduced capacity to synthesize dopamine, have a gross disruption of dopamine release in response to tonic pain and have cortical hyperactivity in response to noxious stimulation are "making it up" or "malingering."

Perhaps we just found out the biological counterpart of what happens in the brain of people who make it up. Perhaps at the point where they start to believe in it themselves. Anyway it's nothing compared to the chemicals my brain releases when i see a hot girl in a short skirt. And that's no disease either. Pizzaman79 (talk) 09:31, 4 March 2009 (UTC)

Or perhaps you would like to offer an intelligent critique of the diagnostic criteria as they currently stand...?

Just what is it you take issue with anyway? Dr. Anymouse (talk) 03:32, 12 September 2008 (UTC)

I'm not here to debate or discuss fibromyalgia; I'm here to try to help write an article according to Wikipedia policies. I've already stated my position quite clearly: I feel no need to repeat myself. Dlabtot (talk) 04:47, 12 September 2008 (UTC)

Works for me. So...be BOLD and write a mini-review of the likes of Drs. Nortin Hadler and G.E. Ehrlich rather than engage in intellectual laziness and poor scholarship by citing self-promoting medical journalists as has been your wont in this regard. (Along the same lines, it may come as some surprise to you, but: world ≠ flat.) --Dr. Anymouse (talk) 01:18, 18 September 2008 (UTC)

I think this is covered in the controversies section, although perhaps it needs expanded and maybe moved towards the start of the article. I've done some work on this section, but I think it requires more. The references need fixed for a start, and I don't have time right now. --sciencewatcher (talk) 15:52, 5 November 2008 (UTC)

I have to agree that the controversies section needs to be expanded. However I feel that when this is brought up it starts a line of argument about the validity of the disease when really this is not the issue, the main issue is that rightly or wrongly the controversy EXISTS. What i mean by that is that there is discourse (extensively on this forum even) that debates FM nature as a disease. I dont understand how this contradicts any truth about the condition. I dont think the present section really gives a good enough insight into the debate. In my experience, many medical proffessionals when asked about fibromyalgia would make some mention on its "realness" either to say it is a so called organic or so called psychiatric illness and therefore i feel that the article is incomplete if it doesnt make good mention of FMs disputed nature.Shaun3001 (talk) 18:10, 20 November 2008 (UTC)

I've added some info to the first paragraph. I haven't added any refs for this info (because I can't find any), so it is really just my summary of the controversy based on what I've read/heard. Feel free to change/edit/revert/rewrite or whatever. --sciencewatcher (talk) 21:15, 20 November 2008 (UTC)

Update: I just found a very good article from the NY Times which covers the controversy very well, and I added it to the article. --sciencewatcher (talk) 21:24, 20 November 2008 (UTC)

That's the same NY Times story that was whitewashed out of the article back in February and that prompted the RfC above. Dlabtot (talk) 21:44, 20 November 2008 (UTC)

I've removed the paragraph you just added because it needs to be radically reworded, i.e. removal of the many weasel words and unreferenced claims e.g. "considerable", "many doctors" when only one is referenced. Once I'd removed those bits the rest of the paragraph made no sense so I removed it in toto. Also the "no objective test" is sailing a bit close to the wind too as examples of what can't be done is is needed to put it into context, e.g. there is no standard blood test that can reveal the malady. Having said that though my daughter was recently diagnosed as a result of a blood test. The diagnosis made was based on the fact that something didn't appear when the doctor expected it to (I have no idea what the doc was looking for). Apparently based on my daughter's symptoms something should have appeared in the blood sample yet it didn't. The remaining conclusion was that fibromyalgia was to blame. --WebHamster 22:43, 20 November 2008 (UTC)

Did you read that NY Times article and the Goldenberg quote? All of the statements are in the refs. If you're unhappy with the wording feel free to change it, but don't just revert the entire section. You appear to want to remove a valid edit simply because of your POV/COI. Now, because of your revert, the article is not NPOV. --sciencewatcher (talk) 22:57, 20 November 2008 (UTC)

Of course I've read it, perhaps you should look above you. You should also read why I deleted it. I deleted it because it made no sense once I'd removed the weasel words. Yes there is controversy, I've never denied that, but "considerable" is a subjective term. Either put the number in or leave it out. Likewise don't refer to "many doctors" when only one is referenced. If you want the para in there then I suggest you reword it. One of the reasons the ref you gave was deleted before is that the article doesn't make things very clear as to what is being referred to in it. It is open to interpretation as to what is actually being referred to in the article. The wording used in your text was not NPOV and was using terms that have been decried by WP editors for quite a while. I have no objection to this section being increased, but do so using tried and trusted WP syntax. --WebHamster 23:08, 20 November 2008 (UTC)

According to wikipedia guidelines you should improve good-faith edits rather than just reverting them. If it doesn't make sense after you remove the bits you don't like, then it's up to you to rewrite it, not me. I ask you again: please either rewrite the section so it is better, or else undo your deletion to show good faith and I'll work with you to address the concerns you have. I'm happy for you to replace "many" with "some" and to remove the word "considerable" if you wish. You can also change the wording for "no objective test" to what it says in the ref if you like. --sciencewatcher (talk) 23:41, 20 November 2008 (UTC)

I don't doubt it was a good faith edit. I have no reason not to. The problem wasn't so much in what you said, more in how you said it. Some of it was factually wrong and some of it was badly worded. I have neither the time nor the inclination to do the research required to make what you were saying accurate and correctly worded. If you want the section to go in then that's up to you. It bothers me not whether it does or whether it doesn't get inserted. The ONLY reason I deleted it was for the reasons given. --WebHamster 13:01, 21 November 2008 (UTC)

Perhaps it is time to request mediation or maybe refile the RfC, which did not garner a clear consensus one way or the other - there just were not a sufficient number of uninvolved editors responding. Dlabtot (talk) 00:18, 21 November 2008 (UTC)

Webhamster, how do you feel the controversy topic could be brought forward and advanced in the article to a consensus opinion? As regards the objective test, would you agree that perhaps the phrase "FM is a diagnosis of exclusion" could be used? Rather than no obejective test s availiable. Shaun3001 (talk) 03:39, 21 November 2008 (UTC)

I've got no problem with that wording, though I have no idea how accurate it is from a medical standpoint. --WebHamster 13:01, 21 November 2008 (UTC)

Here is an excerpt accessed from medscape/emedicine.com "It should be appreciated that a number of treatable and/or life-threatening conditions may present with symptoms that resemble those of FMS, and these obviously need to be excluded before a definitive diagnosis is made." the full text is here- http://www.medscape.com/viewarticle/569749. Shaun3001 (talk) 15:57, 21 November 2008 (UTC)

Fibromyalgia is not a diagnosis of exclusion. If a person meets classification criteria then s/he may be said to have fibromyalgia. If there are other diagnoses to attend to, then the various conditions are considered co-morbid. The distinction between 'primary' and 'secondary' fibromyalgia was struck down in the original ACR 1990 criteria article by Wolfe et al.Dr. Anymouse (talk) 04:41, 23 November 2008 (UTC)

I'm sorry, i think you are wrong there as the above excerpt from a notable source states. Plus, as there are no tests for FMS it is a diagnosis of exclusion by definition. http://en.wikipedia.org/wiki/Diagnosis_of_exclusion . If a person meets this classification criteria you are referring to they may have FMS. Furthermore if a physician diagnosed someone based purely on said criteria without any further tests, that would be extremely negligent. Shaun3001 (talk) 14:50, 23 November 2008 (UTC)

The "tender point" diagnosis is problematic, and it is discussed in the "fibromyalgia: why such controversy" article by Goldenberg. I just haven't had time to put the info into the controversy section yet. If someone else wants to do it, go ahead. --sciencewatcher (talk) 16:26, 23 November 2008 (UTC)

Yeesss...the tenderpoint test is problematic, but I would be very interested to hear what the objective studies for a diagnosis of schizophrenia are, or Parkinson's disease. According to the current diagnostic criteria, the definitive test for fibromyalgia is the manual tenderpoint examination. If a patient has ≥ 11 of 18 points positive, then s/he may be diagnosed as having fibromyalgia. Period. If the fibromyalgia is associated with an additional diagnosis (e.g. rheumatoid arthritis) then one would be accused of negligence not for diagnosing the patient with fibromyalgia but for neglecting to address the fact that his or her immune system has gone haywire and is busy attacking native joint tissues.

BTW, I believe the reference to Wikipedia's stub on diagnosis of exclusion represents an appeal to an unreferenced source. You performed a loop: I support my argument with an unsupported internal reference, akin to saying "A is true because I say it is A." Dr. Anymouse (talk) 17:01, 23 November 2008 (UTC)

Actually I was pointing out the definition of a diagnosis of exclusion. Not that fibromyalgia is listed as such in the article. I fail to see your logic and the problem with defining it as such. You could if you wished refer to parkinsons as a diagnosis of exclusion also as it has no widely availiable clinical test for diagnosis. Is this a dirty word or a heinous insult to the disease? I have provided you with an external source, namely the article from medscape that refers to FMS saying "It should be appreciated that a number of treatable and/or life-threatening conditions may present with symptoms that resemble those of FMS, and these obviously need to be excluded before a definitive diagnosis is made." And the article here as i read it, is not talking about additional diagnoses but alternative ones. Shaun3001 (talk) 18:35, 23 November 2008 (UTC)

And btw the tenderpoint test you are referring to was actually developed for inclusion of subjects tp research with 11 as an arbitary number. It was not intended as diagnostic criteria. Shaun3001 (talk) 18:40, 23 November 2008 (UTC)

Wow! Thanks for great points on practice and the history lesson. (You mean the guys sitting around that cafeteria table at the University of Toronto were interested in promulgating research criteria? Who would have guessed!) You may, however, want to take another glance at the abstract of the 1990 article, particularly the part that says: The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned. (emphasis added, natch)Dr. Anymouse (talk) 14:05, 24 November 2008 (UTC)

Hmmm "newly proposed" not "newly accepted as definitive", says it all really. --WebHamster 14:14, 24 November 2008 (UTC)

Counting tender points is a working case definition, accurate or not. Such definitions are indeed intended for patient selection in research, but they have a way of getting introduced into the clinical setting. A true disease definition should describe the (presumed) cause and nature of the disease, rather than only its symptoms. Guido den Broeder (talk, visit) 15:40, 24 November 2008 (UTC)

"A true disease definition should describe the (presumed) cause and nature of the disease, rather than only its symptoms." Good point! We're working on it ;)Dr. Anymouse (talk) 16:07, 24 November 2008 (UTC)

So how is any of what you've just said mean that FMS isnt a diagnosis of exclusion? Is it just because you say it isnt? The article i have read and referenced above would seem to disagree with you. Shaun3001 (talk) 18:24, 24 November 2008 (UTC)

That is correct: FM is not a diagnosis of exclusion because there are validated criteria for classification of the disorder that, if met, confer the diagnosis. There are no studies to rule it out other than a negative tender point survey. It's like saying if you have have difficulty paying attention, put off initiating tasks that require sustained concentration, and are disruptive in class then you have ADD. Sure, ADD is is 'controversial' but there is also a robust science behind it, including neuroimaging and genetic studies. Just like in FM.

In the case of FM, laboratory tests may be used to rule out the existence of other conditions -- in fact, they may be prudent, depending on clinical circumstances -- but should some other condition be detected (polymyalgia rheumatica, for example) then that does not mean the patient doesn't have FM; rather, it means s/he has FM plus PMR. After all, you can have diabetes plus hypertension, epilepsy plus migraines, etc. The pathophysiology of each is distinct. I would add that this is more than a simple academic argument: hundreds of thousands of dollars (literally!) are spent each year by well-intended but ignorant clinicians who insist on ordering study after study to evaluate patients whose primary underlying problem is FM. If there was a broader understanding of the disorder and the variety of symptoms associated with it, then this would save a lot of money and prevent exposure of patients to unnecessary medical tests and their inherent risk. After all: no one orders multiple MRIs, esoteric blood work or spinal taps to rule out juvenile dementia, polymyositis or pernicious anemia just because a child has cognitive dysfunction and growing pain, right? You simply treat the ADD and get on with it. On the other hand, if you were to be very forward looking and order a sleep study and -- lo and behold -- the child has sleep apnea, wch if treated, causes a resolution of the cognitive problems, it would be reasonable to surmise that intermittent nocturnal hypoxia was causing the child's ADD.

Surprise! The same thing happens in FM. Imagine that... Dr. Anymouse (talk) 19:20, 24 November 2008 (UTC)

oh right, im glad you have cleared that up. Truly I should have just asked for your opinion, I feel foolish having believed the published sources that disagreed with you.... Unfortunately for you, this article isn't about what you think personally. Anything to do with the diagnosis or controversy that anyone else is suggesting is backed up by a source. you simply don't like it. You insist on referring to various other conditions, that is not what this article is about. To be honest I have no strong views on FMS. I simply believe the article should be inclusive not exclusive to suit one viewpoint. Shaun3001 (talk) 21:43, 24 November 2008 (UTC)

No worries, Grasshopper -- and please, don't feel bad. However, for the sake of clarity, I did not offer you an opinion, rather I quoted the primary source (Wolfe et al, 1990) and provided a clinical illustration. Trust me: you don't want my opinion. Really. Dr. Anymouse (talk) 23:01, 24 November 2008 (UTC)

At last we agree. I dont want it and im tring to get it out of this article. Are we naming insects? I have a few i can think of to describe you. Much love. Shaun3001 (talk) 23:56, 24 November 2008 (UTC)

(outdent) Although it may feel good to engage in insults, condescending remarks, belittling labels and sarcasm, this type of behavior is not likely to be helpful in working towards ocnsensus. I suggest a new approach. Dlabtot (talk) 01:07, 25 November 2008 (UTC)

I have removed the references to "Multiple Chemical Sensitivity" because that diagnosis is even more widely disputed, and, unlike FMS, MCS patients have failed double-blind tests. I have moved the references to the controversy from its position in the second paragraph to the subsection on controversies where it belongs, because a reader needs the information organized logically. I have added, in its place, the following statement. "Some health care providers continue to dispute the validity or efficacy of the diagnosis. See "Controversies" below."

I don't think the article's references to the controversy would be complete without reference to FMRI confirmation of abnormalities in patients'. The FMRI studies, of course, do not provide 100%, absolute confirmation of the existence of FMS, but do confirm that patients getting the diagnosis do have a real medical abnormality.

I have also changed some of the wording about the dispute (e.g. I changed "controversial" to "disputed"). However, I personally believe that, given the FMRI studies, the continued dispute by some medical providers either indicates that they aren't keeping up with research or else are maintaining their dissent for personal or non-scientific reasons. But, since they continue their disputes, that much, at least, should be mentioned. I added a clarification to the claim that some alleged "large majority" dispute the diagnosis, to better indicate that such was a quote from "Fibromyalgia wars".

I have not otherwise significantly changed the "controversies" section, although I find it not just confirmation-biased WRT research, but just plain unscientific.

I have expanded and reworded the malingering section and added a statement to tie it into the controversies section. I think the malingering issue is definitely important and should be mentioned, but I think it should be moved into a subsection of the controversies section. I don't know how to do that, so I have, instead, just added verbiage to suggest reading the controversies section.

The souces cited do not verify the statements in the lead. There are NO valid medical sources that state that Fibro is a "non disease" I am removing opnion, not fact. Block me, there a hundred ways to get around being blocked —Preceding unsigned comment added by 70.57.228.12 (talk) 07:07, 7 January 2010 (UTC)

ScientistKeith (talk) 15:04, 10 July 2009 (UTC)