Fibromyalgia - Controversies

Controversies

Fibromyalgia continues to be a disputed diagnosis. 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.

Several theories propose that fibromyalgia is a somatoform disorder.

Several controversial issues exist with regard to fibromyalgia that range from questions regarding the validity of the disorder as a clinical entity, to issues regarding primary pathophysiology and the potential existence of fibromyalgia subtypes.

According to Frederick Wolfe, lead author of the 1990 paper that first defined the ACR fibromyalgia classification criteria,"the large majority of physicians, sociologists, and medical historians" are skeptical about the validity of fibromyalgia as a clinical entity. Some call fibromyalgia a "non-disease" and "an over-inclusive and ultimately meaningless label." Wolfe now questions the validity of fibromyalgia as a disease. He considers fibromyalgia a physical response to stress, depression, and economic and social anxiety, and believes the associated symptoms are a normal part of everyday life. In 2009, he wrote, "the tendency to respond with distress to physical and mental stressors is part of the human condition." Wolfe notes that, "opponents of the fibromyalgia concept argue that, as it is a non-disease, we are legitimising patients' sickness behaviour by providing a disease label."

Yunus has referred to some physicians' belief that FM is psychological in nature as Disturbed Physician Syndrome (DPS): "It is the physicians who are psychologically disturbed because they ignore the data, and whatever data there is, they manipulate it to say what they want it to say."

In a study of 100 individuals identified as having fibromyalgia, physical functioning decreased slightly over time, and individuals who had been diagnosed earlier had larger numbers of reported symptoms and greater severity. However, there was also a statistically significant improvement in satisfaction with health following classification. The authors of the study concluded that the ‘fibromyalgia label’ does not have a meaningful adverse effect on clinical outcome over the long term.

The validity of fibromyalgia as a unique clinical entity is also a matter of contention because "no discrete boundary separates syndromes such as FMS, chronic fatigue syndrome, irritable bowel syndrome, or chronic muscular headaches." Because of this considerable symptomatic overlap, some researchers have proposed that fibromyalgia and other syndromes with overlapping symptoms be classified as functional somatic syndromes for some purposes.

Some researchers believe that differences in psychological and autonomic nervous system profiles among affected individuals may indicate the existence of fibromyalgia subtypes. A 2007 review divides individuals with fibromyalgia into four groups as well as "mixed types":

1. "extreme sensitivity to pain but no associated psychiatric conditions" (may respond to medications that block the 5-HT3 receptor)
2. "fibromyalgia and comorbid, pain-related depression" (may respond to antidepressants)
3. "depression with concomitant fibromyalgia syndrome" (may respond to antidepressants)
4. "fibromyalgia due to somatization" (may respond to psychotherapy).

Other researchers have suggested that depression may be a result of coping with the disabling impacts of a, thus far, incurable disease.