Tuesday, January 31, 2017

Why Fibromyalgia is a Good Name

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.


  1. Do I Diagnose fibromyalgia by Pressing tenderpoints? - yes I do. 2x9 / 18

    1. Is pressing tender points sufficient for the diagnosis? If yes, why not call the condition tender point syndrome?