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== Need for scientific update ==
==Incidence==
"Fibromyalgia is seen in 3% to 6% of the general population"---there's no source... in this article it says it's 2%: http://www.aafp.org/afp/20070715/247.html (] 18:29, 16 August 2007 (UTC))


The entry is based on many old papers and is not up to date regarding recent academic findings. Is there a way to flag this? ] (]) 06:26, 10 August 2021 (UTC)
:Consider it flagged. Have you details of the recent academic findings? We cant do anything without them. -] ] 06:33, 10 August 2021 (UTC)
::There are several papers revolving around (IgG) autoimmunity, this should be added if someone wants to do it. Till now, the article mentions none of it.
::E.g. https://pubmed.ncbi.nlm.nih.gov/34196305/, papers are usually Goebel et al or Karolinska.
::There is even a Phase 2 study with an IgG reducer, cf. https://clinicaltrials.gov/study/NCT05643794. ] (]) 18:38, 13 July 2024 (UTC)
:::That Goebel paper is important. Do you know if it's been discussed in a review paper? I know it's replicated in people with pain in ], but is it also replicated in fibro? Misplaced Pages typically doesn't use primary sources per ], and relies on reviews instead. ] (]) 11:08, 14 July 2024 (UTC)
::::In the paper already mentioned, there is a second cohort already. They checked with Walton Center first, then with a totally different Karolinska cohort. There is also follow-up, eg. https://pubmed.ncbi.nlm.nih.gov/37683961/ from Karolinska. In my mind there was another british group / cohort but not sure.
::::Regarding reviews I'm not aware, only for SFN I think I've read one. I know the Misplaced Pages guideline, but imo it doesn't really make sense in the context of "unexplained" or "psychosomatized" diseases. Reviews are often from a biased set of "experts", where there are different "groups". E.g. very low to no evidence (opinion) "reviews" of psychosomatic proponents (mostly with W.Häuser for finding it online) vs SFN proponent "reviews". Reviews are also not independent, eg psychosomatic proponents reviewing their own group's papers. Everything needs to be judged for quality, also reviews. For example, Cochrane has published a very flawed review on ME/CFS which they acknowledged.
::::Within that regard I also have a problem with WP:medrs advocate for "academic books", that is certainly not automatically better than a paper published by respected authors in a prestigious journal.
::::There are some "consensus" papers from groups and workshops, e.g. https://pubmed.ncbi.nlm.nih.gov/38365860/ or https://pubmed.ncbi.nlm.nih.gov/38873615/.
::::In the end it's a balancing act, WP:medrs works better for well-defined diseases. ] (]) 19:28, 1 August 2024 (UTC)


Agreed. More recent papers are pointing to the existence of FM without paired tender points. The idea is over 30 years old and possibly very wrong. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016048/ ] (]) 00:44, 26 December 2021 (UTC)
I think that the source should indicate to which population it refers. I am not knowledgable about this condition but it is generally of interest to me to be able to distinguish between trends that may be borne of social, econmic, genetic influence.


I wonder whether female sex by itself is a risk factor for fibromyalgia, or just makes someone more likely to be abused (which in turn makes them 3 times more likely to get fibromyalgia). Calling sex a risk factor without controlled evidence looks suspect to me. ] (]) 23:50, 13 April 2023 (UTC)
--13:15, 21 November 2007 (UTC)] (])


== "Marijuana, the Wonder Drug" == == Outdated image ==
In the "Signs and symptoms" section, there is an image of a woman with multiple symptoms. The image is from 2009, and as of 2022 is inaccurate. It includes symptoms such as dizziness, weight gain, skin complaints, urinary problems, twitches and dysmenorrhea that do not appear to be backed up by a reliable source. I suggest removing the image, unless someone would like to update it. ] (]) 05:49, 9 April 2022 (UTC)
Finally ethical professionals are standing up: http://www.iht.com/articles/2007/03/01/opinion/edgrinspoon.php
Nice quotes: <blockquote>"'''Neuropathic pain''' is notoriously resistant to treatment with conventional pain drugs. Even powerful and addictive narcotics like morphine and OxyContin often provide little relief. This study leaves no doubt that '''marijuana can safely ease''' this type of pain."<br><br>"If marijuana were a new discovery rather than a well-known substance
carrying cultural and political baggage, it would be hailed as a wonder
drug."<br><br>''Lester Grinspoon, an emeritus professor of psychiatry at Harvard Medical School, is the coauthor of "Marijuana, the Forbidden Medicine."''</blockquote>
It's time this option were legal -- because some of us have no
alternatives left. Step up and send this article to your congressional
reps.
Can someone work this stuff into the article? There's a lot more research on this treatment that can be added as well -- though most of it is research by pharmaceuticals trying to cash in. --] 06:25, 3 March 2007 (UTC)


:The image has been removed at some point between this comment and now. <span style="color:#AAA"><small>&#123;{u&#124;</small><span style="border-radius:9em;padding:0 5px;background:#088">]</span><small>}&#125;</small></span> <sup>]</sup> 20:32, 29 November 2023 (UTC)
:No specific reference to fibromyalgia - not suitable for inclusion. ] 16:15, 26 June 2007 (UTC)


== Images ==
It is also not an effective treatment for some as it has been tested with no pain alleviation, at least in my case.] 19:46, 28 June 2007 (UTC)


{{u|SigTif}}, I am looking at the changes you're currently making with inserting images, and it doesn't look to be an improvement. The articles are not galleries, and the images (at time of this comment) do not add anything in themselves. That is, the sentence {{green|Irritable bowel syndrome and fibromyalgia share similar pathogenic mechanisms}} has value, and should simply be in the body of the article; putting that as the caption of the image ] does not add value: not only is the image so vague as to not really convey any information, this is in the ''fibromyalgia'' article, where it doesn't even seem relevant. Similarly, the replacement of the image in the infobox is not an improvement: the previous image was informative and conveyed information, the current one is effectively just clip-art: an image of a person with their hand on their neck (]) does not convey any information. Remember, articles do not ''have'' to have images, even in the infobox; this is the sort of image you would put in an infobox if they were required and you had absolutely nothing better to put there. I see you have put the <nowiki>{{in use}}</nowiki> template up, so I will not touch the article until that is removed, but I figured I would add this comment before you put in too many images that don't add anything. ] (]) 18:38, 15 December 2023 (UTC)
==Lyrica/Pregabalin treatment ==


:I understand, Feel free to delete and unneeded images. ] (]) 18:58, 15 December 2023 (UTC)
The FDA recently approved the use of Lyrica (pregabalin, a gabapentin precursor) for fibromyalgia. This is the first time a drug has actual on-label use for fibromyalgia.
::I went ahead and reverted all of the image insertions. I also reverted the infobox image and caption change: putting a list of symptoms in the infobox image's caption is not useful, because the infobox already has a parameter listing symptoms. I also took out another image that's in this same vein, i.e., is not adding value in the article, that was already in the article before the edits I reverted. ] (]) 19:16, 15 December 2023 (UTC)
http://www.fda.gov/bbs/topics/NEWS/2007/NEW01656.html
::] and ] are the justification for removing these images that are irrelevant or do not add value/information to the article. ] (]) 19:18, 15 December 2023 (UTC)


==Wiki Education assignment: Science Writing==
I believe some fibro advocates have suggested that someone finally figured out that fibromyalgia might be a lucrative market, and as gabapentin recently went generic, Pfizer wanted a solid market for Lyrica. No one has yet tested whether Lyrics is more effective than gabapentin vs. fibromyalgia, of course.
{{dashboard.wikiedu.org assignment | course = Misplaced Pages:Wiki_Ed/University_of_Wisconsin-Eau_Claire/Science_Writing_(Spring) | assignments = ] | reviewers = ] | start_date = 2024-01-30 | end_date = 2024-05-10 }}


<span class="wikied-assignment" style="font-size:85%;">— Assignment last updated by ] (]) 15:10, 2 April 2024 (UTC)</span>
Regardless of the controversy, the FDA approval should certainly be added and cited.
] 09:34, 28 June 2007 (UTC)


== Add A Fact: "Managing fibromyalgia symptoms" ==


I found a fact that might belong in this article. See the quote below
==Living with...==
<blockquote>
Living with the syndrome seems most closely related to treatment, but a consensus is needed (see ])
There is no cure for fibromyalgia, but doctors and other health care providers can help manage and treat the symptoms. Treatment typically involves a combination of exercise or other movement therapies, psychological and behavioral therapy, and medications.
</blockquote>
The fact comes from the following source:
: https://www.niams.nih.gov/health-topics/fibromyalgia


Here is a wikitext snippet to use as a reference:
== Methadone ==
<nowiki> {{Cite web |title=Fibromyalgia |url=https://www.niams.nih.gov/health-topics/fibromyalgia |website=National Institute of Arthritis and Musculoskeletal and Skin Diseases |date=2017-04-05 |access-date=2024-11-21 |language=en |first=NIAMS Science Communications and Outreach |last=Branch |quote=There is no cure for fibromyalgia, but doctors and other health care providers can help manage and treat the symptoms. Treatment typically involves a combination of exercise or other movement therapies, psychological and behavioral therapy, and medications.}} </nowiki>
Additional comments from user: I am trying out the new chrome extension to see if this information can be incorporated under prognosis,


This post was generated using the ] browser extension.
hi I found that methadone is a good choice for fibromyalgia. isn't it?
http://www.revolutionhealth.com/drugs-treatments/rating/methadone-for-fibromyalgia-syndrome-fms
hope that helps <small>—Preceding ] comment added by ] (]) 08:24, 15 November 2007 (UTC)</small><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->


] (]) 09:19, 21 November 2024 (UTC)
All theories should all have verifiable references, preferably medically sound and researched
All Misplaced Pages information should be written from a "Neutral Point-of-View" (see ])

==Fibromyalgia as Severe TMS==

The diagnosis of ] (]) has been used since 1984 by ] of the ] and his followers to designate a mindbody disorder that causes chronic back, neck, or limb pain that is frequently mistaken for structurally caused pain. Dr. Sarno says on p.62-63 of ''Healing Back Pain: The Mind-Body Connection'' (1991) "Typical of these reports is one published in the ''Scandinavian Journal of Rheumatology'' in 1986 (Vol 15, p.165) by N.Lund, A. Bengtsson and P. Thorborg titled 'Muscle Tissue Oxygen Pressure in Primary Fibromyalgia.' Using an elegant new laboratory tool, they were able to measure muscle oxygen content with great accuracy and found that it was low in the painful muscles of patients with fibromyalgia."

"What this means for the etiology (cause) of TMS, as I have long maintained, is that fibromyalgia, also known as fibrosis and myofibrositis (and to some as myofasciitis and myofacial pain), is synonomous with TMS. I have treated a large number of patients who came with the diagnosis of fibromyalgia; their medical histories and physical examinations were consistent with severe TMS. As proof that the diagnosis was correct, they recovered completely."

In his later book, ''The Mindbody Prescription: Healing the Body, Healing the Pain'' (1998) in which he expanded the TMS diagnosis to other TMS equivalents based on his long experience at the ], he says on pp 76-77, "I have maintained for years that fibromyalgia was a severe form of TMS. The similarity of my findings to the diagnostic criteria of the American College of Rheumatology reinforces that diagnostic conclusion."
"People with fibromyalgia commonly have psychological symptoms as well. They are often anxious and depressed, have sleep problems and suffer from lack of energy."
"Since fibromyalgia ia part of TMS, I have seen and sucessfully treated many patients who had been given that diagnosis before they came to me."

In Dr. Sarno's latest book, ''The Divided Mind: The Epidemic of Mindbody Disorders'' (2006), he says on pp.21-22, "''Fibromyalgia'' is a medical term that has been around for a long time. For some reason it was adopted by the rheumatology community in the early 1980s and applied to patients suffering pain in many locations in the trunk, arms, and legs. In fact, it is a severe form of TMS. Significantly, fibromyalgia patients commonly suffer from other mindbody disorders as well, like headache and irritable bowel syndrome, as well as emotional symptoms including anxiety, depression, and sleep disorders. When rheumatologists first became interested in people with these symptoms, they were not able to explain what caused the disorder, but they created diagnostic criteria to define it. That became a kind of medical kiss of death. The American College of Rheumatology decreed that the diagnosis could be made if the person under examination exhibited pain in eleven of a potential eighteen locations. Since that time, hundreds, if not thousands, of papers have been published describing studies that try, still unsuccessfully, to explain the disorder. Two of these published studies of people with fibromyalgia found that the oxygen levels in their muscles was reduced, confirming the hypothesis that fibromyalgia is a manifestation of TMS, which we've seen is caused by mild oxygen deprivation."

"But the rheumatology community community did not accept the idea of mild oxygen deprivation as the cause of fibromyalgia, and the epidemic continued. By the year 2000 the enormous increase in the number of people with this diagnosis prompted an article in ''The New Yorker'' magazine by Jerome Groopman, a professor of medicine at Harvard, in which he noted that there were ''six million'' Americans (mostly women) with this disorder of unknown cause and that it appeared to be analogous to the nineteenth-century epidemic of neurasthenia."

"The fibromyalgia story is another tragic example of the epidemic proclivity of psychosomatic disorders when they are misdiagnosed and, therefore, inevitably mismanaged." ] 02:34, 11 September 2007 (UTC)

==Skepticism==
Removed skepticism again. This really has no basis. ] 00:04, 15 May 2007 (UTC)

Removed skepticism as it is conspicuously missing from other articles with a similar nature to fibromyalgia, if it is to be included, it should be placed under ALL such articles.] 07:30, 12 May 2007 (UTC)

So just because other articles are incomplete this article should follow suite? Bravo John E. Average Misplaced Pages, Bravo! ] (]) <small>—Preceding ] was added at 07:44, 30 November 2007 (UTC)</small><!--Template:Undated--> <!--Autosigned by SineBot-->

==Necessity of skepticism section==

I am new to this article, though I stumbled here after reading one of the reviews in the New England Journal of Medicine (Vol. 354 No. 9) pp. 983-984, by Nortin Handler M.D. In it he posits a different concept of Fibromyalgia, stating that it may be an over arching faulty diagnosis, More research should be done. Here is a larger quote from him that I include mostly complete as to not take out of context and also provide for those who may not have access to the NEJM. "However, Fibromyalgia is not an opiate-responsive, tissue specific pain state. It is a far more global state of painfulness, where suffering is much more than an overtone. No one "has" fibromyalgia, or "suffers" from fibromyalgia; one "is" fibromyalgia. What does "central sensitization" mean in such a state? No doubt patients with fibromyalgia have a distintive neurophysiology that supports an altered somatic sensibility and reactivity." and "...They are afflicted with the distinctive neurophysiology of a pathogenetic idea. Such ideas need to be recognized and explained, so that research and treatment focus on neural plasticity as it pertains to complex intellectual constructs. There is no disease to cure."

Many find faults with the diagnostic criterion set by the ACR as being faulty in logic. The objection is that it is a "...neologism adopted in 1990 by members of a committee who were convinced that no other rubric did justice to the plight of their patients who were suffering persistent widespread pain in the absence of objective pathobiology, but who were characterized for their singular antipathy to being poked in particular sites -- "tender points" -- on their bodies." He goes on to state that the committee may have improperly introduced diagnostic criteria that simply defines those who they felt were unlabeled. "... the members where testing their diagnostic hypothesis on the very patients they used to generate their notion of fibromyalgia -- a classic pitfall in logic." In fact stress and distress can produce similar hypersensitivity. I believe that this type of skepticism should be welcomed into any scientific discussion. Not a derisive skepticism, but one which states that there may be too much of a focus on have "a" diagnosis, instead of the correct diagnosis. I posit that a skepticism section be allowed and furthermore maintained in this article as it has basis in medical community.

Out of respect for all of those who have put so much of their time and effort into this article, I will not make unilateral changes but welcome your input as you have definitely been working with this article for longer than myself. ] 04:57, 13 July 2007 (UTC)

:I agree with ]. A skepticism section is certainly appropriate. Go ahead and add it. ] 06:04, 13 July 2007 (UTC)
::Some things to worry about are ] and ], particularly undue weight. If Dr. Handler is the minority or if research has not yet been done to confirm his hypothesis, then the most that should go into an article is a single line stating the opinion. We don't report without sources and we don't report ]. ] 21:33, 14 July 2007 (UTC)

:::Thanks for the quote and your POV about what is derisive and what is not derisive scepticism. I would support your notion - but only if you also include the missing scepticism sections into multiple sclerosis, aids, cancer, autism etc. Unless you are willing to do that I am against it. As for your Doctor Hadler: I am sure it will surprise you, but there is some scepticism about "your" scepticism. (Ralphyde: That's your cue to start screaming at the top of your voice: "NOOO! HADLER SAYS THE TRUTH, THE TRUTH")
:::Hadler has many verbose critics, like http://www.rheuma21st.com/archives/cutting_edge_fibro_wolfe.html As the author has included his own references in published journals we can and will use them to dissect your upcoming so called "scepticism" section with some "counter scepticism".
:::Here is quote: "The thrust of Hadler's fibromyalgia complaint is this. Fibromyalgia does not exist unless we create it. According to Hadler those labeled with fibromyalgia are distressed individuals whose ability to cope is exhausted and whose invincibility is challenged, persons who find their living unsatisfactory, even desperately wanting, and feel the need to describe the lacking. In evaluating this Hadlerian definition of fibromyalgia we should first ask if it is true. Richard Feynman reminds us that "...it doesn't matter how beautiful your theory is, it doesn't matter how smart you are -- if it doesn't agree with experiment, it's wrong."
:::Here is another quote by Robert M. Bennett, MD, FRCP, FACP, FACR, Professor of Medicine and Chairman Division of Arthritis and Rheumatic Diseases, Oregon Health Sciences University, Portland, Oregon, USA(http://www.rheuma21st.com/archives/cutting_edge_fibro_benett.html) about Hadler (who is also being made fun of at amazon for his obfuscating and obscure writing style):
:::"Unfortunately, Dr. Hadler's fanciful prose and philosophizing has not kept up with the wealth of new information on the scientific underpinnings of chronic pain states."
:::Also, you might want to do some googling about the two week old FDA-approval for Gabapentin for fibromyalgia. And while you are at it, rummage through pubmed for fibromyalgia. If you are new to the entire topic do some reading first. The Hadler&Friends-it's-all-the-head ship has sailed some time ago.
:::Finally, you might take a deep breath and meditate (all in your head) about the tremendous harm you are potentially causing to the patient community
::::Hey, don't look at me. I've never even heard of Dr. Hadler. I only agreed with ] that a skepticism section was appropriate. And you forgot to sign your post. ] 20:32, 17 July 2007 (UTC)
Wow, I thought it was a reasonable request, but I apparently touched a nerve. To answer your question about skepticism sections in other disease articles:

There are several for HIV/AIDS.

There is the minority hypothesis in Autism of its origins being related to teratogenic effects from Thiomersal, a mercuric antifugal agent at one time included in the MMR vaccine.

For MS, though not definitive there has been an extreme amount of research into its cause, and through animal models and specifically targeted monoclonal antibody Selective Adhesion Molecule inhibitors such as Natalizumab's potency it has very well supported the notion of T-cell mediated inflammation.

There is also skepticism in regards to ADD/ADHD, whether in being too general a diagnosis or being a organic disorder at all, even with evidence such as PET and fMRI scans.

All that I am saying is that there is (and I will secede that it is possibly a minority) dispute as to whether or not Fibromyalgia is an appropriate diagnosis or if it is simply an umbrella term for neuropathic pain (And to the unnamed poster, neuropathic pain often treated by gabapentin).

I think that some people may think that because I bring up doubts as to the veracity of the diagnosis that I am attacking them. I have no doubt that sufferers of Fibromyalgia are suffering from true neuropathic pain. I just am bringing up an at least minority view of skepticism of Fibromyalgia as a diagnosis. ] 02:05, 16 August 2007 (UTC)

: I think the rheumatological community has pretty much accepted the concept that Fibromyalgia is a blanket term for several conditions -- something I've tried to reflect in the introduction. I'm not sure "Skepticism" is the right wording here, as no one doubts that the individuals are in pain. "Diagnostic Uncertainty" might be a more appropriate term. ] <sup>(])</sup> 02:27, 16 August 2007 (UTC)

:: Point well taken. I do believe that we agree. As I was describing before, I was just reading through the NEJM and came upon that article. I was talking with several of my colleagues who seemed to be in agreement about this. I was just hoping that Misplaced Pages would have more substance as to that point of view. ] 03:16, 18 August 2007 (UTC)

::: Go ahead and add the section in and I'll try to edit it from some Rheumatological sources I can dig up. Regards, ] <sup>(])</sup> 15:16, 19 August 2007 (UTC)

==References==
Is anyone else concerned that there is no bibliography for this article?

==External Links==

I would like to have http://fibromyalgia.ning.com/ considered for the list of external links. It's a great community that focuses on this topic and seems to me like a valuable resource for people coming to the Fibromyalgia page in Misplaced Pages looking for information. ] (]) 15:20, 25 December 2007 (UTC)
---

Is there a reason why the link to the documentary film, Living With Fibromyalgia, was removed? I found it through this article a while back and found it to be a great resource that was very balanced about this condition while still hopeful. As far as I can tell, it's the only feature-length, recent documentary that features the stories of real patients with the condition as well as doctors. I know when it was done it was with the blessing of the National Fibromyalgia Association. I just told a new patient to look for this link on this article and saw that it was gone now. I'm very new to this, so please excuse me if I'm not sure how this should work. I'd like to add this as an external link if it won't be removed again.] 00:23, 4 December 2007 (UTC)

I agree with Wikieditorba15 in looking for resources for my mother-in-law I found the documentary film, Living With Fibromyalgia to be a nice introduction to the topic for the family.--] (]) 19:42, 3 January 2008 (UTC)
::You can't really add a link to a whole movie. Does it have its own wikipage? You could link to that in the body or see also section. ] (]) 19:47, 3 January 2008 (UTC)

==Recent edits==
Major reworking, have provided reference for genetic predisposition and other contentious sections. Have merged ] and commented out para on people faking the test for benefit and insurance fraud. Still a work in process.

IANAD but was diagnosed with fibromyalgia this year, although I've had symptoms all my life. I had been previously diagnosed with chronic fatigue fyndrome in 1997 but began to suspect I had fibromyalgia in 2002 when I started getting pain. A lot of sites I've linked to are sites I've found useful. I hope that people who read the article when I've finished editing it will come away with a better understanding of fibromyalgia, and that people living with the syndrome will find information they previously may have missed. Am keeping NPOV policy in mind :-) ] 00:36, Dec 27, 2004 (UTC)


:My doctor told me that the theory that it is psychosomatic has been thrown out the window and that it is widely accepted to be mostly genetic. I will try to find references for this, because it's insulting to those of us with FM to imply that we are "making it up," or could "get over it" if we just tried hard enough. Also, there have been recent studies in the use of Cymbalta for controlling FM pain, and it is a drug currently prescribed by doctors for that purpose. I'm not sure where that would be added. ] 16:01, 7 June 2007 (UTC)

::You're responding to a comment that is 2.5 years old, you might want to make sure that the above is still an issue on the page. ] 18:20, 7 June 2007 (UTC)

:::I put it under recent edits because that's what it was. I must have misunderstood the correct procedure. Yes what I mentioned is still an issue, because one of the first things it says is that "some physicians believe that it may be psychosomatic or psychogenic".{{unsigned|75.160.96.177}}

::::It's not the best title for the section, as 'recent' does change. ] guidelines suggest new comments should go at the bottom of the page, though your understanding of the situation is valid and makes sense. If you've got sources, by all means put them it, it'll definitely improve the page! The Cymblta info would go in ] However, if you are the user who added the caffeine comment, note that if you don't have a source beyond personal experience, that's considered ]. ] 20:19, 7 June 2007 (UTC)

:::::Please tell me what the caffeine comment was. I just learned I have FM, and just discovered that drinking lots of Coca Cola causes my body to "feel better" - it could be the caffeine. Do you also feel better by drinking Coca Cola? ] 23:48, 11 August 2007 (UTC)

==Why was the section about disability removed?==

I remember seeing a section about this a couple months ago on this page -- who removed it and why? A number of FM patients are disabled as a result of the disease. The Social Security Administration (U.S.) acknowledges fibro as a disability, however, only pays support for those with severe cases (i.e. bedridden for months at a time).

It really seems to me like someone came to this page with an agenda...

--] 15:14, 27 June 2006 (UTC)

Meg,
Let me guess, you yourself have FM and now ASSUME someone else has an "agenda" against you? Geesh. You just confirm why so many MD's doubt that FM is physical, but instead may be a psychological disorder that should be seeking psychiatric help for better resolution of symptoms.

: Some MD's doubt FM isn't a physical disorder because they are basing their opinions on outdated research (mostly a lack thereof). Many disorders go through a phase during which people wonder if they are real or not. While there is a ton of good, solid research that now shows that fibromyalgia is real, it takes time for people to become aware of that research. Doctors are human and they already have a lot to do. Most don't have time to do much research of their own, particularily if it is about a disorder not directly a part of their field. Therefore, it is not surprising that many doctors have not for some reason made themselves more knowledgeable about one of many disorders. They are, however, less common than they used to be. The question that you should be asking is why so many psychologists and psychiatrists do believe that fibromyalgia is a physical problem! I have seen a few personally to ensure that there was not such an underlying issue and they all agree that I am mentally sound and that there is nothing they can do for me, so I hope you will their and my word for it. Another question for you - how come people with fibromyalgia are not cured (or treated to the point of normal or near normal function) by psychiatric help or drugs if it is a psychiatric disorder? ] 04:12, 25 January 2007 (UTC)

That's a pretty rash conclusion. No, I do not think someone same to this page with an agenda. Rather, I believe someone came to this page grossly misinformed. It is no secret that there are indeed quite a few medical professionals who edit topics on Misplaced Pages. It is also no secret that there are many medical professionals who are completely ignorant to the true nature of this disease. To exclude a section about disability in an encyclopedia article about a disease that is a disability and disables people to the point where they file (and win) SSDI claims, to me, is irresponsible. ] 17:59, 8 June 2007 (UTC)

==Bias section==
The following absolutely had to be deleted...

:Because the nature of fibromyalgia is not well understood, some physicians believe that it may be ] or ].<ref>{{cite book |author=Sarno JE, et al| title=The Divided Mind: The Epidemic of Mindbody Disorders |year=2006 |isbn=0-06-085178-3 |pages=21-22, 235-237, 264-265, 294-298, 315, 319-320, 363}}</ref> Although there is no universally accepted cure, some doctors have claimed to have successfully treated fibromyalgia when a psychological cause is accepted.<ref>{{cite book |author=Leonard-Segal A | title=The Divided Mind: The Epidemic of Mindbody Disorders |year=2006 |isbn=0-06-085178-3 |pages=264-265 |quote=I have successfully treated many patients who carry the diagnosis of fibromyalgia. … It is almost as though those with fibromyalgia have so many issues from which the pain distracts them, that they accumulate pain in many locations as their defense mechanism. … As with other TMS patients, those with fibromyalgia can be helped if they are open to considering and then accepting that there is a psychological cause for their pain. If they are unable to be open in this way, I have not been able to help them.}}</ref>

This is biased, incorrect, and violates neutrality. ] 18:09, 8 June 2007 (UTC)

::Dear Meg, The statements you have deleted are absolutely true and are cited. Some physicians '''do''' believe fibromyalgia is psychosomatic, and they are the ones actually curing people who have been diagnosed with fibromyalgia. Dr. Andrea Leonard-Segal, who is quoted in the section you deleted, is a board certified Rheumatologist and internist, and a Clinical Professor of Medicine at George Washington University Medical School, and she treats patients at the Center for Integrative Medicine at George Washington University Medical Center. She is one of eight separate physicians in the above cited book who believe that fibromyalgia is psychosomatic. Dr. Sarno has been curing such patients since 1984, but only if they can accept that their disorder is psychologically or emotionally caused. If they cannot accept that, however, they remain in pain. You are the one who is biased, because you cannot accept that possibility. Have you read the book, '''Freedom From Fibromyalgia: The 5 Week Program Proven to Conquer Pain'''? The authors, Dr. Nancy Selfridge and Franklynn Peterson, both cured themselves of fibromyalgia by using mindbody techniques, and are now curing others. This is the new paradigm, and you are shutting it out. We had this discussion before in the section on "Fibromyalgia as severe TMS." I wish healing for you, which is now possible, if you can only open yourself to that possibility. ] 20:31, 8 June 2007 (UTC)

:::It reads fine to me and is sourced. Some physicians probably ''do'' believe it is psychogenic, and some ''claim'' cures. Doesn't say or even imply that it is a purely psychogenic, only that some doctors believe it to be so. If it's true, and there is a source to say some doctors believe it so, it deserves to be in the article. It does not mean that it's true and it's not phrased that way, so I don't see the problem. ] 01:32, 9 June 2007 (UTC)

::::The statement does not belong in the opener, it belongs in a section about etiology.
::::If the statement were to remain in the opener, it would be in violation of undue weight, as there are plenty of other theories, some of them stating the complete opposite.
::::If the statement is edited into the opener again, there must be at least one statement at the other main theories about etiology in order not to violate undue weight - which would be a very ugly solution.
::::The sourcing is in my view at best doubtful, as medical articles have to live up to higher standards (One Book, as somebody else stated is not good enough).
::::I would prefer Ralphyde to find another place for his statement than the opener.] 15:49, 26 June 2007 (UTC)

:::Oops, I retract aspects of my previous statement - the info should go in the article, but should definitely not go in the intro. It should be as you said in the treatment section; placing it in the intro does indeed give it undue weight. I'll replace it once I'm done archiving. ] 16:25, 26 June 2007 (UTC)

::::Totally agreed, glad someone else could see what I was getting at. Thank you very much for making the change! ] 19:43, 31 October 2007 (UTC)

== Contradict tag ==

The statement:
"The cause of fibromyalgia is currently unknown."
contradicts this from ]:
"However, in late 2001, her silicone breast implants ruptured, causing fibromyalgia and they were removed."
] 14:07, 14 February 2007 (UTC)

:I don't see how there is a contradiction. Ruptured breast implants appeared to cause fibromyalgia in one woman. However other women who have had ruptured breast implants did not get fibromyalgia. Therefore there is no reason to think that rupturing breast implants cause fibromyalgia. Maybe it was the stress which triggered the fibromyalgia. I think the contradict tag should be removed - it is inappropriate here. --] 16:38, 15 February 2007 (UTC)

::As the neccessary edits (a mention with references in "other theories") have been done, and there is no no contradiction at all, the tag has been removed. ] 01:02, 16 February 2007 (UTC)

:::Sciencewatcher is close. The contradiction was that the fibromyalgia article said the cause was unknown while the Bianca Trump article said that her fibromyalgia WAS CAUSED by ruptured implants. Even with the addition to this article of the now disproven claim, there was a conflict, as this article says only that some CLAIM there is a causal link. I have made one additional edit to the Bianca Trump article, making it clear that some have SPECULATED that the ruptured implants caused the fibromyalgia. Previously, it said the rupture DID cause fibromyalgia, which is unproven. ] 21:47, 19 February 2007 (UTC)

Add a new external link
Hello
I would like to add a link to the Fibromyalgia Support Group for Surrey and Sussex at www.fibromyalgia-south.com. This website is not only about the support group but also gives valuable information about fibromyalgia and has a fantastic links section.
The group runs many activities to help members and keep them up-to-date with the latest developments. They will also help anyone thinking of starting a support group or collaborating with an existing group.
Thanks
] 11:15, 29 March 2007 (UTC)

== Review ==

Narrative review on pathophysiology http://www.annals.org/cgi/content/abstract/146/10/726?etoc ]&nbsp;|&nbsp;] 07:25, 15 May 2007 (UTC)

==Wikisorting==
I've had a go at upgrading the valid references. Those that were from blog sites, or self admitted as giving opinions not accepted by anyone else I've removed (under ] trivial opinions should not be mentioned at all). Several of the references were duplicates. Some of the references were reports of specific research papers, and so I have given these references with then the explanatory lay article added in the style suggested by ]. On moving out the drugs under research from those currently used, it was apparent that antidepressant/anti-epileptic groups mentioned in a duplicate manner - I've coalesced these to individual paragraphs. ] <sup> ] </sup> 01:40, 1 June 2007 (UTC)

==Theory credit==
As the author of the mucus/inflammation/toxin & colon/sinus/dehydration theory, I would like to add my name for credit, Gene Brock. I also think chronic fatigue syndrome is related. Check my IP address and the original posting.

:I have left a message on this user's IP address talk page. Please do not add original research to Misplaced Pages, see ]. All the best. ] 07:44, 22 June 2007 (UTC)

== Disputed section ==

An anon IP has been attempting to replace the following section on the page. I think it's bogus. Some physicians is weasely and there's no citation. It's not particularly well written and contains original research (in bold). The immune support referene is spammy and contains no actual references. ] 14:06, 1 July 2007 (UTC)

;Skepticism
''Some physicians do not acknowledge there is an organic cause of fibromyalgia. They say fibromyalgia is merely a label for ] patients, along with diseases such as ] and ]. Fibromyalgia has also been called a "wastebasket" diagnosis, usually meaning that the doctor does not acknowledge real pathology or consistent disease. '''This should not be taken to mean that the symptom complex of fibromyalgia does not exist, but rather that they do not have a somatic cause.''' At present time, few medical authorities believe that ] and psychological factors (like ]) are the root cause of the syndrome.{{citeneeded}}

: ''"This isn't a disease, it's merely a description of symptoms... We've taken stress, psychosocial distress and pain and the ordinary life experiences some people have and turned them into something they're not -- a physical illness"''

: -- , a skeptical ] who helped define the disease earlier in his career .''

==Human Growth Hormone==
People with fibromyalgia fail to produce sufficient HGH and treatment with HGH alleviates many symptoms. This is key to low IGF, low cortisol levels, high levels of neuropeptide Y, etc.

I'd like to add some of this info. Anyone else here care to help?
--] 02:48, 16 July 2007 (UTC)

== Leonard-Segal Edit War ==

To Pacula and Ralphyde: I haven't had enough time to examine the veracity of the source in question, but it doesn't look like spam on first inspection. If the respective editors could give some rationales on why they believe this source should (or shouldn't) be included, perhaps we can avoid an edit war?
] <sup>(])</sup> 23:49, 10 September 2007 (UTC)

:Thanks for your post. Pacula has been on a rampage, deleting anything related to psychosomatic medicine. I have been trying to restore things to the way they were before his destructive editing, but he follows me around deleting anything I fix. The source is verifable and relevant. ] 02:17, 11 September 2007 (UTC)

::Please don't take this the wrong way Ralphyde, but my reversion is not necessarily a support of your view -- I was merely trying to prevent an edit war. Would you mind justifying why you believe the source is relevant and verifiable? ] <sup>(])</sup> 02:40, 11 September 2007 (UTC)

:::I've added a talk section on "Fibromyalgia as Severe TMS" above, which used to exist but was removed some time ago. It's a legitimate theory, proven by the fact that many people have been cured of their fibromyalgia using mindbody treatments. Dr. Andrea Leonard-Segal is a board certified internist and rheumatologist, and is a Clinical Professor of Medicine at GWU Medical School, and helps people overcome pain at the Center for Integrative Medicine at George Washington University Medical Center. She was cured of her own chronic back pain by Dr. Sarno using his mindbody method, and said in her article, "A Rheumatologist's Experience with Psychosomatic Disorders", "thus began the most profound and rewarding medical education that I had experienced both personally and professionally. This education became a new pathway to benefit patients in a simple, noninvasive, and confidence-building way." She adopted his methods and ended her article by saying, "The beauty of the TMS diagnosis is that it is a hopeful one that can result in a true cure. The treatment leads to resumption of full physical activity, the emergence of a more emotionally healthy life, and an education in self-awareness. The patient who has recovered from TMS grows into a happier, more comfortable, more peaceful person who sees new paths toward greater personal fulfillment." The article is verifiable through the Amazon.com "Search inside" feature. I hope this helps. ] 03:20, 11 September 2007 (UTC)
::::Do you have any sources that fit ] criteria? www.pubmed.org is a good place to start. The book from Amazon is self-referencing and the additional information is original research. ] <sup>(])</sup> 03:30, 11 September 2007 (UTC)

:::My reasoning seemed valid at the time, but I'm not quite as sure now - would be grateful for a little bit of third-party input on the matter. Simply put, I removed this, along with a large number of others, because it was refering (directly or otherwise) to an extremely non-NPOV article (]) on a ] subject that basically read like an advertisement for the books it used as reference. Most of the references to this article/advertisement seemed barely relevent, so I thought it best if I tried to sweep up the mess as much as possible. - ] 04:57, 11 September 2007 (UTC)

::::Given the tenuousness of the diagnosis, and the complete lack of acceptance for TMS in the mainstream medical community, the mention should be pretty minimal in my mind. Adding anything referenced by Sarno's books (beyond the diagnosis and ''potential'' link) is out as far as I know; it'd have to be peer-reviewed journal stuff in my opinion. ] 00:36, 14 September 2007 (UTC)

== Link ==

] is attempting to add a support site to the page. I don't think it's necessary. What do other contributors think? The DMOZ link has a list of 20 support groups, and this isn't adding any ] information to the page in my opinion. Here's teh link:

{{cite web | url = http://www.fmnetnews.com/basics-symptoms.php | title = Fibromyalgia Network | accessdate = 2007-10-18 | language = english | year = 2007 }}

] 16:32, 18 October 2007 (UTC)

== Fybromyalgia ==

I have fibromyalgia. I am wanting to know if anyone else with this condition has other disabilities? I have arthritis, bursitis, osteoporosis, scoliosis, and bone spurs on my spine. The symptoms with Fibromyalgia are so painful and debilitating. Then add all the other conditions puts my life almost at a stand still. I don't have any energy to clean our home, let alone hold down a job(which I can't do). Excercise lays me up for days, just climbing stairs is a feat in itself. Is there any out ther that would like to share information with me concerning these conditions? It would be greatly appreciated. Thank You. CCradick ] 02:09, 28 October 2007 (UTC)

I am a woman with all these conditions and I just turned 48 yrs. old. So you can see how upsetting it can be with all this to deal with on a daily basis. Thank You again.] 02:13, 28 October 2007 (UTC)

:CCradick, there are many support forums on the Internet for this... I don't think this is the right place to post something like this! I will take another look at the article and maybe add an external link to one of the support forums... I feel that is appropriate and would be a beneficial "add". ] 19:43, 31 October 2007 (UTC)


:::Meg, well excuse me for trying to have a converstion about my conditions and asking if anyone else had problems other than fibromyalgia. You go ahead and find other support forums. But you shouldn't get so crappy to someone like me considering it was only my second or third time making edits. I'm just learning about things here at Misplaced Pages. So, before getting an attitude, you should have already found those other support forums before replying to my edit. Also don't wait so long to tell me or anyone else we or our conversations don't belong in this area of discussion] 22:10, 3 November 2007 (UTC)] Nov.3 2007

::::There is a clear header at the top of this talk page reminding that "This is the talk page for discussing improvements to the Fibromyalgia article. This is not a forum for general discussion about the article's subject.", see ] (also whilst I agree ], also ] is required). ] <sup> ] </sup> 02:52, 4 November 2007 (UTC)

::Forums and support groups are generally not approproate, unless the article is about that group or website itself. See ], for ] or listing service (can always Google for support groups). ] <sup> ] </sup> 01:27, 1 November 2007 (UTC)

== Methadone ==

hi I found that methadone is a good choice for fibromyalgia. isn't it?
http://www.revolutionhealth.com/drugs-treatments/rating/methadone-for-fibromyalgia-syndrome-fms
hope that helps <small>—Preceding ] comment added by ] (]) 08:59, 14 November 2007 (UTC)</small><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

== Several clinical entities? ==

''Fibromyalgia may actually be composed of several clinical entities, ranging from a mild, idiopathic inflammatory process in some individuals, to a somatoform disorder resulting from clinical depression in others, with probable overlaps in between.''

While sourced, this seems a very strange statement to me. It is certainly not in accordance with the WHO classification. Secondary depression is always possible, but a mix of a distinctly physical and a distinctly psychiatric condition exceeds my imagination. Most likely, there is something wrong here with the patient selection. ] (]) 10:54, 25 December 2007 (UTC)

: It does indeed fit w/ WHO criteria as the classification for fibromyalgia is that of a ] rather than a disease. In clearer terms, fibromyalgia is a term used to describe a constellation of clinical signs. They may stem from a single clinical entity (as in AIDS w/ HIV) or could be several clinical entities who exhibit similar symptoms (as in toxic shock syndrome and many different species of bacterium.) ] <sup>(])</sup> 23:19, 3 January 2008 (UTC)

::You forget that it also has a classification code, which puts the diagnosis under a heading (see the link to the ICD10), which excludes entities like the psychiatric ones mentioned. ] (]) 11:36, 4 January 2008 (UTC)

:::Sure, but ICD coding is for medical billing and insurance purposes only. From a pathophysiology standpoint, the underlying mechanism(s) for disease has not been elucidated. ] <sup>(])</sup> 22:28, 4 January 2008 (UTC)

::::The ICD is far more than that (the medical billing purpose is only a USA thing, I believe). The classification reflects, or is supposed to reflect, the consensus among scientists and clinicians. Anyway, the lead should not contain a statement that is not widely supported. It could be moved to another place in the article, perhaps. ] (]) 12:21, 5 January 2008 (UTC)

::::OK, I have moved some stuff to a new section 'proposed causes and pathophysiology'. ] (]) 13:17, 5 January 2008 (UTC)
::::Moved the main section on causes to that point. Noticed some hidden treatment info, so not happy yet. ] (]) 19:58, 5 January 2008 (UTC)
::::::The citation provided reflects a consensus statement from the American College of Rheumatology, so I am confused on why you believe it is speculative and controversial. ] <sup>(])</sup> 04:09, 6 January 2008 (UTC)
:::::::Perhaps because it is not based on evidence, and contradicts the WHO classification? ] (]) 10:13, 6 January 2008 (UTC)

Please refrain from deleting well-cited text from internationally recognized Rhematology journals just because you do not like them. The information is relevant to the introduction and is well established within the medical community. If you have a problem with the statement, then produce a <b>citation</b> that backs up your claim. ] <sup>(])</sup> 04:06, 6 January 2008 (UTC)
:Please respect ] and ]. Try to finish the discussion first. If you have evidence that the statement is well-established, provide it. Otherwise it should not be singled out to put in the lead. You may have overlooked that the study is already mentioned in the causes section. ] (]) 10:06, 6 January 2008 (UTC)

==talk page changes==
I removed some of the single-equal sign headings, they screw up the formatting and don't appear to help. ] (]) 19:46, 3 January 2008 (UTC)

Latest revision as of 09:19, 21 November 2024

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Need for scientific update

The entry is based on many old papers and is not up to date regarding recent academic findings. Is there a way to flag this? SigTif (talk) 06:26, 10 August 2021 (UTC)

Consider it flagged. Have you details of the recent academic findings? We cant do anything without them. -Roxy the grumpy dog. wooF 06:33, 10 August 2021 (UTC)
There are several papers revolving around (IgG) autoimmunity, this should be added if someone wants to do it. Till now, the article mentions none of it.
E.g. https://pubmed.ncbi.nlm.nih.gov/34196305/, papers are usually Goebel et al or Karolinska.
There is even a Phase 2 study with an IgG reducer, cf. https://clinicaltrials.gov/study/NCT05643794. 2003:EC:6F19:2200:A0EF:9214:1BBE:D39A (talk) 18:38, 13 July 2024 (UTC)
That Goebel paper is important. Do you know if it's been discussed in a review paper? I know it's replicated in people with pain in long covid, but is it also replicated in fibro? Misplaced Pages typically doesn't use primary sources per WP:medrs, and relies on reviews instead. —Femke 🐦 (talk) 11:08, 14 July 2024 (UTC)
In the paper already mentioned, there is a second cohort already. They checked with Walton Center first, then with a totally different Karolinska cohort. There is also follow-up, eg. https://pubmed.ncbi.nlm.nih.gov/37683961/ from Karolinska. In my mind there was another british group / cohort but not sure.
Regarding reviews I'm not aware, only for SFN I think I've read one. I know the Misplaced Pages guideline, but imo it doesn't really make sense in the context of "unexplained" or "psychosomatized" diseases. Reviews are often from a biased set of "experts", where there are different "groups". E.g. very low to no evidence (opinion) "reviews" of psychosomatic proponents (mostly with W.Häuser for finding it online) vs SFN proponent "reviews". Reviews are also not independent, eg psychosomatic proponents reviewing their own group's papers. Everything needs to be judged for quality, also reviews. For example, Cochrane has published a very flawed review on ME/CFS which they acknowledged.
Within that regard I also have a problem with WP:medrs advocate for "academic books", that is certainly not automatically better than a paper published by respected authors in a prestigious journal.
There are some "consensus" papers from groups and workshops, e.g. https://pubmed.ncbi.nlm.nih.gov/38365860/ or https://pubmed.ncbi.nlm.nih.gov/38873615/.
In the end it's a balancing act, WP:medrs works better for well-defined diseases. 2003:EC:6F19:2200:4278:4F99:30C6:C78D (talk) 19:28, 1 August 2024 (UTC)

Agreed. More recent papers are pointing to the existence of FM without paired tender points. The idea is over 30 years old and possibly very wrong. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016048/ 50.46.9.58 (talk) 00:44, 26 December 2021 (UTC)

I wonder whether female sex by itself is a risk factor for fibromyalgia, or just makes someone more likely to be abused (which in turn makes them 3 times more likely to get fibromyalgia). Calling sex a risk factor without controlled evidence looks suspect to me. 2601:441:4900:A6E0:6CEF:A62F:D2DB:454 (talk) 23:50, 13 April 2023 (UTC)

Outdated image

In the "Signs and symptoms" section, there is an image of a woman with multiple symptoms. The image is from 2009, and as of 2022 is inaccurate. It includes symptoms such as dizziness, weight gain, skin complaints, urinary problems, twitches and dysmenorrhea that do not appear to be backed up by a reliable source. I suggest removing the image, unless someone would like to update it. SigTif (talk) 05:49, 9 April 2022 (UTC)

The image has been removed at some point between this comment and now. {{u|Sdkb}}20:32, 29 November 2023 (UTC)

Images

SigTif, I am looking at the changes you're currently making with inserting images, and it doesn't look to be an improvement. The articles are not galleries, and the images (at time of this comment) do not add anything in themselves. That is, the sentence Irritable bowel syndrome and fibromyalgia share similar pathogenic mechanisms has value, and should simply be in the body of the article; putting that as the caption of the image File:Irritable_bowel_syndrome.jpg does not add value: not only is the image so vague as to not really convey any information, this is in the fibromyalgia article, where it doesn't even seem relevant. Similarly, the replacement of the image in the infobox is not an improvement: the previous image was informative and conveyed information, the current one is effectively just clip-art: an image of a person with their hand on their neck (File:Fibromialgia.jpg) does not convey any information. Remember, articles do not have to have images, even in the infobox; this is the sort of image you would put in an infobox if they were required and you had absolutely nothing better to put there. I see you have put the {{in use}} template up, so I will not touch the article until that is removed, but I figured I would add this comment before you put in too many images that don't add anything. Kimen8 (talk) 18:38, 15 December 2023 (UTC)

I understand, Feel free to delete and unneeded images. SigTif (talk) 18:58, 15 December 2023 (UTC)
I went ahead and reverted all of the image insertions. I also reverted the infobox image and caption change: putting a list of symptoms in the infobox image's caption is not useful, because the infobox already has a parameter listing symptoms. I also took out another image that's in this same vein, i.e., is not adding value in the article, that was already in the article before the edits I reverted. Kimen8 (talk) 19:16, 15 December 2023 (UTC)
WP:NOTGALLERY and WP:IMAGEDD are the justification for removing these images that are irrelevant or do not add value/information to the article. Kimen8 (talk) 19:18, 15 December 2023 (UTC)

Wiki Education assignment: Science Writing

This article was the subject of a Wiki Education Foundation-supported course assignment, between 30 January 2024 and 10 May 2024. Further details are available on the course page. Student editor(s): Alea m12 (article contribs). Peer reviewers: Smcc24.

— Assignment last updated by Smcc24 (talk) 15:10, 2 April 2024 (UTC)

Add A Fact: "Managing fibromyalgia symptoms"

I found a fact that might belong in this article. See the quote below

There is no cure for fibromyalgia, but doctors and other health care providers can help manage and treat the symptoms. Treatment typically involves a combination of exercise or other movement therapies, psychological and behavioral therapy, and medications.

The fact comes from the following source:

https://www.niams.nih.gov/health-topics/fibromyalgia

Here is a wikitext snippet to use as a reference:

 {{Cite web |title=Fibromyalgia |url=https://www.niams.nih.gov/health-topics/fibromyalgia |website=National Institute of Arthritis and Musculoskeletal and Skin Diseases |date=2017-04-05 |access-date=2024-11-21 |language=en |first=NIAMS Science Communications and Outreach |last=Branch |quote=There is no cure for fibromyalgia, but doctors and other health care providers can help manage and treat the symptoms. Treatment typically involves a combination of exercise or other movement therapies, psychological and behavioral therapy, and medications.}} 

Additional comments from user: I am trying out the new chrome extension to see if this information can be incorporated under prognosis,

This post was generated using the Add A Fact browser extension.

SigTif (talk) 09:19, 21 November 2024 (UTC)

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