Problems With Labeling the Problem With the Word “Fibromyalgia”

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The word “fibromyalgia” is the latest of a very long list of words that have been used over the past 100 years for a poorly defined syndrome involving chronic widespread muscular pain and a large number of other symptoms. It is a bad term because it is mis¬leading in that it suggests the disorder has something to do with fibrous tissue. In general, “fibro” refers to cells in the body called fibrocytes. The syndrome had previously been labeled fibrositis. The suffix “itis” suggests the disorder involves inflammation. Based on considerable research by multiple authors, it has become clear that fibromyalgia has little to do with fibrocytes or inflammation.

The same cannot be said of “myalgia” which means muscular pain and which is a unifying symptom pattern in these patients. Until more is known about it pathophysiology, it is going to be very difficult to classify it as a specific disease.

It is fair to say that fibromyalgia is a syndrome if by the word “syndrome” we mean a range of symptoms with a range in levels of severity. This range is from minor transient cases to chronic severe debilitating cases.

There have been critics that say that fibromyalgia does not exist. One of the arguments they make is that it is hard for the believers in this condition to say specifically what it is. Part of the problem is that it may be wrong to assume it is a very specific dis¬ease. We do however now have widely accepted criteria for fibromyalgia as provided by the new American College of Rheumatology guidelines. (The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Daniel J. Clauw, Mary-Ann Fitzcharles, Don L. Goldenberg, Robert S. Katz, Philip Mease, Anthony S. Russell, I. Jon Russell, John B. Winfield, Muhammad B. Yunus, Arthritis Care Res 2010;62:600–610, available in full online at: http://onlinelibrary.wiley.com/doi/10.1002/acr.20140/full.)

Diagnostic criteria for fibromyalgia have been shifting in recent years. For about 20 years since 1990, the tender points were used as one of the criteria. Patients had to have at least 11 of the eighteen.

There is a danger in medical diagnostics of what is called reification. This occurs when doctors create a label for a syndrome such as fibromyalgia, and then they and the public assume it is a clear-cut disease entity, when in fact it might be little more than a label for a group of related patterns.