The term
Fibromyalgia has coined in the 1970ies and 1980ies. There has been a lot of
controversy on how to diagnose this syndrome and how to call it.
Do you
diagnose fibromyalgia by pressing tender points?
Do you look/
ask for widespread pain?
Do you have
to exclude other diseases?
How many lab
tests and X-ray charts do you need?
Do you punch
biopsy for small fiber neuropathy?
Do you use
classification criteria as a diagnostic tool?
Are you
afraid of the diagnosis fibromyalgia?
Do you deny
that there is a syndrome called fibromyalgia? Then, how do you call it?
Do you think
that fibromyalgia is a psychogenic pain or do you better to call it pain
disorder? [The German term is “somatoforme Schmerzstörung”, it literally means somatoform
pain disorder]
What do you
think that gulf war syndrome, chronic fatigue syndrome, multiple chemical
sensitivity are?
Do you
believe in the pain of your patient, if there isn’t any backing somatic
finding?
Does your
patient have to prove to have pain?
Do you
differentiate between acute and chronic pain?
What other
differentiations do you use? Peripheral/nociceptive – neuropathic –
central/non-nociceptive?
Do you
assess pain intensity and quality?
Do you ask
for allodynia and hyperalgesia?
Which
non-pain related symptoms do you assess?
How do you assess
sleep disorders in fibromyalgia patients?
Do you think
that sleep disorders are cause or consequence of fibromyalgia?
Do you think
that diagnostic criteria are helpful?
Is it
difficult for you to diagnose fibromyalgia?
Do you
screen for factors that would lead to pain chronification?
Are women
more often suffering from fibromyalgia than men?
Do you
think, that fibromyalgia could be surgically removed?
Do you think
that a > 50% reduction in 28.9% of verum patients vs. 13.2% of placebo patients
is an argument for a drug, when dizziness as one of many adverse events is seen
in 65% verum patients vs. 15% of placebo patients?
Do you
prescribe drugs? Do you feel better then?
If you
prescribe antidepressants, is the patients doing better or is the patient just
better to handle?
I don’t
think that denying someone’s pains is helpful – it increases pain.
I don’t
think that a discussion on how else we could call fibromyalgia is leading to
alleviate pain.
I think, we
should be happy to have a name for this pain syndrome, which is much more than
pain. It is a good name, which had been coined by the necessity to give the
syndrome a name, when patients showed up in rheumatology offices with symptoms
like stiffness, joint and muscular pain, which didn’t fit into an inflammatory
diagnosis like polyarthritis or polymyalgia.
I call it
fibromyalgia. I use M79.70 and F45.41 of ICD-10 to classify it.
