Is Fibromyalgia a Psychosomatic Illness? Med Student Asks Celeste Cooper

I received a request from a medical student taking an abnormal psychology class. He wanted to know if I thought fibromyalgia was a psychosomatic disorder.

The Psychology Dictionary defines psychosomatic disorder as:

Psychosomatic disorders are those in which psychological factors play a major role in the origin or course of the disorder.

Following is my response

[Medical student,]

You are offering others a great opportunity to learn by writing on this topic. I hope to give you the information you need [regarding whether fibromyalgia is a psychosomatic illness or not]… I will answer your questions bluntly.

"Fibromyalgia is NOT a psychosomatic illness."

While talk therapy, biofeedback, mindfulness for any chronic illness is important for coping, it will not cure or even eradicate symptoms from a physical underlying disorder. This is also true for fibromyalgia. There are many people, including myself, who have been through extensive therapy with the hopes that we could find something to help our pain. My co-author began as my therapist. He assured me that I do not have a psychosomatic illness, and encouraged me to validate that with a psychiatrist, which I did, and it was found that I do not. 

The Right Diagnostic Criteria is Critical to Understanding Fibromyalgia

Unfortunately, Dr. Frederick Wolfe has done a great deal of damage to the fibromyalgia patient. He has touted his criteria for diagnosing FM as the American College of Rheumatology criteria. I wrote to the ACR on this and they tell me they have NOT endorsed Dr. Wolfe’s or anyone else’s criteria. See my blog, [The ACR Responds to My Inquiry on the Fibromyalgia DiagnosticCriteria—Should I Scream or Cry?]  It is my understanding that the ACR is publishing an erratum on this matter in an issue of Arthritis Care and Research.

Dr. Wolfe resurrected the antiquated notion that fibromyalgia is a psychosomatic illness with his research on prevalence offibromyalgia in the German community (Wolfe, et. al., 2013).  What you don’t know is that he took a validated tool for assessing severity of somatic symptoms, the PHQ-15 (Kroenke, et. al., 2002) and tweaked it.

Dr. Wolfe’s “short form,” called the PHQ-8, regarded:

1. stomach or problems going to the toilet
2. pain in the back
3. pain in the arms, legs, or joints
4. headaches
5. chest pain or getting out of breath
6. dizziness
7. feeling tired or having low energy
8. trouble sleeping

First, why are stomach problems and problems going to the toilet lumped together? The PH-15 divides these somatic symptoms between 1) stomach pain 2) constipation, loose bowels or diarrhea and 3) nausea, gas, or indigestion. Secondly, is it 4) chest pain, or 4a) shortness of breath? These are divided in the PHQ-15. Where is the assessment for 5) fainting and 6) feeling your heart race? Patients with fibromyalgia do have 7) pain with intercourse, particularly if they have comorbid chronic pelvic pain. This “short form” could affect the outcome regarding severity of symptoms when compared to the validated PHQ-15 tool. Isn’t it possible that the validated tool is validated because of the way the questions are asked?

He even says, “The PHQ-15 is best characterized as a measure of somatic symptom severity.” So why didn’t he use it? That is the $100,000 question. Why did this escape a peer reviewed journal editor? 

The Role of Fibromyalgia Diagnostic Criteria

Roland Staud, MD et. al. (University of Florida, Gainesville, 2010) had this to say, in part, about the provisional diagnostic criteria which was later modified, but they bring up some good points to help with your questions.

“...After a series of analyses, Wolfe et al concluded that a widespread pain index was the best predictor of FM. When this index was excluded from the analysis, key predictors of FM were nonrefreshing sleep, fatigue, cognitive difficulties, and a host of somatic symptoms... there is a glaring omission of well-known mechanistic FM features, such as hyperalgesia, central sensitization, or dysfunctional pain modulation...Also, the somatic symptom list is extremely broad somatic symptoms, and the symptoms are ordered by neither relevance nor predictive value, etc., supposedly contributing equally to FM. In conclusion, whether or not these new criteria are easy to apply by practicing physicians will require empirical testing. Unfortunately, the new criteria are imprecise, ill-defined, lack mechanistic features, and are completely symptom focused…”

This has been my opinion as well. To simply list somatic complaints without further investigation is cause for alarm. The ACR suggests comorbid conditions, tension headache or migraine, digestive problems (i.e. irritable bowel syndrome, gastric reflux) irritable or overactive bladder, pelvic pain, and temporomandibular disorder, causing face or jaw pain, jaw clicking and ringing in the ears. And, they recognize depression or anxiety as a disorder that can accompany fibromyalgia, which can accompany any chronic illness. (Accessed 6-26-2015).  Other things may explain the somatic complaints, such as hypothyroidism, cancer, and much more.

Dr. Katsuhiro Toda (Japan) wrote a letter to the editor or Arthritis Care and Research on the provisional criteria, (Wolfe, 2010) which you can access here. And,  he wrote a letter  tothe editor of the Journal of Rheumatology, The Modification of the American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia Should Be Supplemented and Revised (Wolfe, 2011) of interest. “…In Japan, many physicians have ignored fibromyalgia. Therefore, patients with fibromyalgia are often diagnosed with psychogenic pain or somatoform disorder…”  

You might also be interested in seeing this editorial in the journal “Rheumatology.”  and Dr. Smythe’s article, which also outlines the lack of specificity in the Wolfe criteria.

Dr. Robert Bennett has contributed over 500 papers on fibromyalgia, he is considered an expert, and he led the research for theAlternative Diagnostic Criteria (Bennett, et al., 2014). You can read my blog regarding the criteria, and on my website.

I encourage you to visit my blog, look in the archives and you will see that I have written on MANY topics regarding fibromyalgia.   

Be sure to search PubMed. Connect the dots by searching fibromyalgia along with any one of the comorbid disorders. For instance, a study just published on fibromyalgia and migraine. You will find there has been more than one connection made between fibromyalgia and small fiber neuropathy and fibromyalgia too.

I have found that when one person has a question, someone else will too. Therefore, I will be sharing this information on my blog.

I am attaching a resource list for you and I will include reference to some recent studies that might help you. Good luck and please keep me updated. I would love to see what you come up with for your class.

Best regards, Celeste Cooper

Resources:

Abeles, M* and Abeles, AM. The New Criteria forFibromyalgia: Evolution or Devolution?

Bennett R, Friend R, Marcus D, Bernstein C, Han BK, Yachoui R, Deodar A, Kaell A, Bonafede P, Chino A, Jones K. Criteria for the diagnosis of fibromyalgia: Validation of the modified 2010 preliminary ACR criteria and the development of alternative criteria. Arthritis Care Res (Hoboken). 2014 Feb 4. doi: 10.1002/acr.22301. [Epub ahead of print]

Kroenke K1, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002 Mar-Apr;64(2):258-66.

Smythe HA. Unhelpful criteria sets for "diagnosis"and "assessment of severity" of fibromyalgia. 

J Rheumatol. 2011 Jun;38(6):975-8. doi: 10.3899/jrheum.110142.

Staud R, Price DD, Robinson ME. The provisional diagnostic criteria for fibromyalgia: one step forward, two steps back: comment on the article by Wolfe et al. Arthritis Care Res (Hoboken). 2010 Nov;62(11):1675-6; author reply 1676-8. doi: 10.1002/acr.20290.

Toda K. Preliminary diagnostic criteria for fibromyalgiashould be partially revised: comment on the article by Wolfe et al. Arthritis Care Res (Hoboken). 2011 Feb;63(2):308-9; author reply 309-10. doi: 10.1002/acr.20358.  

Toda K. The Modification of the American College ofRheumatology Preliminary Diagnostic Criteria for Fibromyalgia Should BeSupplemented and Revised. J Rheumatol 2011;38;2075

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010 May;62(5):600-10. doi: 10.1002/acr.20140.

Wolfe F1, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011 Jun;38(6):1113-22. doi: 10.3899/jrheum.100594. Epub 2011 Feb 1.

Wolfe F1, Brähler E, Hinz A, Häuser W. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care Res (Hoboken). 2013 May;65(5):777-85. doi: 10.1002/acr.21931.

Other:

Antonio R Zamunér MSc, PT*, Meire Forti PT, Carolina P Andrade PT, Mariana Arias Avila PhD, PT andEster da Silva PhD, PT RespiratorySinus Arrhythmia and its Association with Pain in Women with FibromyalgiaSyndrome. Article first published online: 1 JUN 2015 DOI: 10.1111/papr.12321

Caro XJ, Winter EF. Evidence of abnormal epidermal nerve fiber density in fibromyalgia: Clinical and immunologic implications. Arthritis Rheumatol. 2014 Apr 9. doi: 10.1002/art.38662. [Epub ahead of print]

Flodin P1, Martinsen S, Löfgren M, Bileviciute-Ljungar I, Kosek E, Fransson P.

Fibromyalgia Is Associated with Decreased Connectivity Between Pain- and Sensorimotor Brain Areas. Brain Connect. 2014 Aug 7. [Epub ahead of print]

García JJ1, Cidoncha A2, Bote ME3, Hinchado MD3, Ortega E3. Altered profile of chemokines in fibromyalgia patients. Ann Clin Biochem. 2014 Sep;51(Pt 5):576-81. doi: 10.1177/0004563213506413. Epub 2013 Oct 8.

Giannoccaro MP, Donadio V, Incensi A, Avoni P, Liguori R. Small nerve fiber involvement in patients referred for fibromyalgia.  Muscle Nerve. 2014 May;49(5):757-9. doi: 10.1002/mus.24156. Epub 2014 Jan 28. 

Garcia JJ, Ortega E. Soluble fractalkine in the plasma of fibromyalgia patients.

An Acad Bras Cienc. 2014 Dec 9;0:0. [Epub ahead of print]

Inal S1, Inal EE, Okyay GU, Oztürk GT, Oneç K, Güz G. Fibromyalgia and nondipper circadian blood pressure variability. J Clin Rheumatol. 2014 Dec;20(8):422-6. doi: 10.1097/RHU.0000000000000189.

Jones GT1, Atzeni F, Beasley M, Flüß E, Sarzi-Puttini P, Macfarlane GJ. The prevalence of fibromyalgia in the general population - a comparison of the American College of Rheumatology 1990, 2010 and modified 2010 classification criteria. Arthritis Rheumatol. 2014 Oct 16. [Epub ahead of print]

Kosek E1, Altawil R2, Kadetoff D3, Finn A4, Westman M2, Le Maître E2, Andersson M5, Jensen-Urstad M6, Lampa J2. Evidence of different mediators of central inflammation in dysfunctional and inflammatory pain--interleukin-8 infibromyalgia and interleukin-1 β in rheumatoid arthritis. J Neuroimmunol. 2015 Mar 15;280:49-55. doi: 10.1016/j.jneuroim.2015.02.002. Epub 2015 Feb 19.

Kosmidis ML1, Koutsogeorgopoulou L1, Alexopoulos H1, Mamali I1, Vlachoyiannopoulos PG1, Voulgarelis M1, Moutsopoulos HM1, Tzioufas AG1, Dalakas MC2. Reduction of Intraepidermal Nerve Fiber Density (IENFD) in the skin biopsies of patients with fibromyalgia: A controlled study. J Neurol Sci. 2014 Sep 28. pii: S0022-510X(14)00633-9. doi: 10.1016/j.jns.2014.09.035. [Epub ahead of print]

Light AR, Bateman L, Jo D, Hughen RW, Vanhaitsma TA, White AT, Light KC. Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome. J Intern Med. 2011 May 26. doi: 10.1111/j.1365-2796.2011.02405.x. [Epub ahead of print]

Napadow V1, Harris RE.What has functional connectivity and chemical neuroimaging in fibromyalgia taught us about the mechanismsand management of 'centralized' pain? Arthritis Res Ther. 2014;16(5):425.

Oaklander AL, Herzog ZD, Downs H, Klein MM. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. 2013 Jun 5. pii: S0304-3959(13)00294-7. doi: 10.1016/j.pain.2013.06.001. [Epub ahead of print]

Olivan-Blázquez B1, Herrera-Mercadal P2, Puebla-Guedea M2, Pérez-Yus MC2, Andrés E3, Fayed N4, Hoyo YL5, Magallon R6, Roca M7, Garcia-Campayo J8. Efficacy of memantine in the treatment of fibromyalgia: a double-blind randomised controlled trial with 6-month follow-up. Pain. 2014 Sep 10. pii: S0304-3959(14)00424-2. doi: 10.1016/j.pain.2014.09.004. [Epub ahead of print]

Riva R1, Mork PJ, Westgaard RH, Okkenhaug Johansen T, Lundberg U.Catecholamines and heart rate in female fibromyalgia patients. .J Psychosom Res. 2012 Jan;72(1):51-7. doi: 10.1016/j.jpsychores.2011.09.010. Epub 2011 Oct 24.

Shmygalev S, Dagtekin O, Gerbershagen HJ, Marcus H, Jübner M, Sabatowski R, Petzke F. Assessing Cognitive and Psychomotor Performance in Patients with Fibromyalgia Syndrome. Pain Ther. 2014 Oct 25. [Epub ahead of print]

Sugimoto C1, Konno T2, Wakao R3, Fujita H1, Fujita H1, Wakao H1. Mucosal-associated invariant T cell is a potential marker to distinguish fibromyalgia syndrome from arthritis.

PLoS One. 2015 Apr 8;10(4):e0121124. doi: 10.1371/journal.pone.0121124. eCollection 2015.

http://www.ncbi.nlm.nih.gov/pubmed/25853812

Tsai PS1, Fan YC, Huang CJ. Fibromyalgia Is Associated With Coronary Heart Disease: A Population-Based Cohort Study. Reg Anesth Pain Med. 2014 Nov 26. [Epub ahead of print]

Nurcan Üçeyler, Susanne Kewenig, Waldemar Kafke, Sarah Kittel-Schneider and Claudia Sommer. Skin cytokine expression in patients with fibromyalgia syndrome is not different from controls. BMC Neurology 2014, 14:185  doi:10.1186/s12883-014-0185-0

Veldhuijzen DS, Sondaal SF, Oosterman JM. Intact cognitive inhibition in patients with fibromyalgia but evidence of declined processing speed.J Pain. 2012 May;13(5):507-15. doi: 10.1016/j.jpain.2012.02.011.

Vij B1, Whipple MO2, Tepper SJ1, Mohabbat AB2, Stillman M1, Vincent A2. Frequency of Migraine Headaches in Patients With Fibromyalgia. Headache. 2015 May 21. doi: 10.1111/head.12590. [Epub ahead of print]

Wallace DJ1, Gavin IM, Karpenko O, Barkhordar F, Gillis BS. Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis andsystemic lupus erythematosus: a potentially useful tool in differentialdiagnosis. Rheumatol Int. 2014 Nov 7. [Epub ahead of print] 

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"Adversity is only an obstacle if we fail to see opportunity."  

Celeste Cooper, RN

Author—Patient—Health Central Chronic Pain Pro —Advocate

NEW Website: http://CelesteCooper.com

Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog. 

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

”FIBROMYALGIANESS”—Patient Harm: The Facts and the Effects of Fibromyalgia Diagnostic Criteria by Celeste Cooper

Someone recently shared a comment made by her physician at Duke University that horrified me. I was appalled that a physician would make such a statement, so I want to share my reaction with you. It goes like this…

Duke University physician reportedly said:

"You do know that fibromyalgia is just a word we use 

to talk about psycho-somatic pain, don't you?"

Could it be she read “The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity”? (Wolfe, 2014). In a letter to follow this blog, I will be looking into whether or not the American College of Rheumatology has approved the 2010 criteria. It appears they consider comorbid conditions of migraine and IBS (here) that are not considered in the Wolfe criteria as follows:”

“Of the binary variables, irritable bowel syndrome, abdominal pain, and headache had variable importance. However, they added no power to correct classification and we did not include them in the diagnostic criteria.” (Page 208, Wolfe, et al., 2010).

Could it be this Duke University physician is unaware of what others in the field have to say? See “ACR 2010 criteria for fibromyalgia critiqued by: Mary Ann Moon, Family Practice News Digital Network, here. 

Could it be that she did not see Dr. Sean Mackey’s lecture at Stanford University that I believe supports key elements in the 2013 Alternative Diagnostic Criteria? You can view it here.

This attitude toward fibromyalgia must be stopped in its tracks if we are to maintain forward momentum. There is a great deal of empirical evidence showing FM is biological. Yet, despite repeated research that the brain of the FM patient does not respond to painful stimulus in a normal way, (not only the emotional center, but also the center in the brain that specifically interprets pain), many practitioners, even those from Duke University, are ignorant. The 2010 Preliminary Proposed Diagnostic Criteria modified in 2011 set forth by Dr. Frederick Wolfe are endangering the many strides taken to understand fibromyalgia over the past 100+ years.

“[Fibromyalgia] has been known to exist for more than a hundred years. Symptoms of what we know today as FM were first described in the seventeen hundreds, and the disorder was first observed and documented by British surgeon William Balfour in 1816. In 1904 the same collection of symptoms was recognized by another British fibromyalgia pioneer, Sir William Gowers, who described chronic soft tissue syndromes as fibromyositis.” (Excerpt Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection.)

http://www.dsm5.org/

We also have the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association's (APA) to thank for what Dr. Wolfe calls FIBROMYALGIANESS. Marly Silverman and I wrote about, and predicted, this two years ago in a piece on the prospects of the DSM-5.     

I have been in collaboration with well-respected fibromyalgia expert Dr. Robert Bennett, and have written a blog explaining his well-researched diagnostic criteria, which DOES consider all aspects of fibromyalgia. He and his colleagues report their findings without bias. I hope you will read that blog here. Pay close attention to the example of the 2013 Alternate Fibromyalgia Criteria (2013 Alt FM Criteria) and the proven tools such as the Fibromyalgia Impact Questionnaire (see: http://fiqrinfo.ipage.com/). Following is an excerpt from that blog with my comments.

*1. “Fibromyalgia patients have a continuum of symptoms; a diagnosis based on a strict numerical cutoff is subject to error.” In other words, a physician or nurse practitioner should not be limited by a subjective questionnaire. They should rely on their abilities to physically assess a patient with hands-on exam to assess physical complaints, take a patient history, order and interpret test results, complete a physical exam, and apply their diagnostic skills. No practitioner should limit the scope of their abilities. Without these expert assessments, we would not know that the tender point count has not stringently met the 1990 ACR criteria.

*2. “The presence of another pain disorder or related symptoms does not rule out a diagnosis of fibromyalgia.” We know from the literature that fibromyalgia can and often does coexist with certain other disorders, such as those defined by the CDC. Dr. Wolfe's modification of his 2010 criteria suggests in point three under the description of the criteria above in order to diagnose fibromyalgia, “the patient does not have a disorder that would otherwise sufficiently explain the pain.

* 3. “A careful clinical evaluation is always required in order to identify any condition that could fully account for the patient’s symptoms and/or contribute to the severity of the symptoms.” A clinical evaluation includes the parameters mentioned above in *1. The Bennett investigators conclude that a patient’s symptoms should be investigated seriously and not be dismissed as poly-symptom somatic complaints as suggested by the Wolfe team of investigators. This is important because many of the symptoms fibromyalgia patients experience can be attributed to other treatable conditions that affects patient outcome.

I had to respond to the likes of the Duke University doctor, because she is not alone thanks to the likes of Dr. Wolfe who uses unapproved APA tools and handpicked databases for his research. I am not a scientist, nor a statistician, however I did conduct a study while in college, and I can tell you that doing an unbiased literature review is research 101. Choosing only literature that fits your hypothesis is flawed. Oddly enough, or not so oddly enough, I recently saw an article in a Physicians online journal “Healthcare Professionals Network” here that suggested Dr. Bennett endorsed the 2010 Wolfe Criteria carte blanche. In fact, the Bennett Alternative Criteria published in the September issue of Arthritis Care and Research, (Bennett, et al. 2014), includes a comparative analysis. Yet, this reporter made no mention that the 2013 Alternate Criteria outperformed the Wolfe, et al 2010 modified criteria in key areas. This partiality makes his report nothing short of propaganda.

Remember, if your physician is not helping you feel better physically, mentally, and emotionally, they have issues, not you! If they are not conducting a physical exam and considering common comorbid conditions to fibromyalgia, they are negligent. If you are harmed by their disregard for your complaints or inconsiderate statements, report them. (See the links on my website here.) Next time, record your visit. Plenty of chronically ill patients need to have counseling for dealing with their symptoms, but to need it because of a doctor that took an oath to do no harm is unacceptable.

postea: added after original blog post:

To whom it may concern—American College of Rheumatology… Criteria for Diagnosing Fibromyalgia, by Celeste Cooper

http://fmcfstriggerpoints.blogspot.com/2014/11/to-whom-it-may-concernamerican-college.html#.VFpus_nF86w

Resources:

Albrecht PJ, Hou Q, Argoff CE, Storey JR, Wymer JP, Rice FL. Excessive Peptidergic Sensory Innervation of Cutaneous Arteriole-Venule Shunts (AVS) in the Palmar Glabrous Skin of Fibromyalgia Patients: Implications for Widespread Deep Tissue Pain and Fatigue. Pain Med. 2013 May 20. doi: 10.1111/pme.12139. [Epub ahead of print]

Behm FG, Gavin IM, Karpenko O, Lindgren V, Gaitonde S, Gashkoff PA, Gillis BS. Unique immunologic patterns in fibromyalgia. BMC Clin Pathol. 2012 Dec 17;12(1):25. doi: 10.1186/1472-6890-12-25.

http://www.biomedcentral.com/1472-6890/12/25

Bennett RM. Opinion on preliminary guidelines for the clinical diagnostic criteria for fibromyalgia Practical Pain Management, July/August, 2010, Volume 10 (6) pages 76-79. 

Bennett R, Friend R, Marcus D, Bernstein C, Han BK, Yachoui R, Deodar A, Kaell A, Bonafede P, Chino A, Jones K. Criteria for the diagnosis of fibromyalgia: Validation of the modified 2010 preliminary ACR criteria and the development of alternative criteria. Arthritis Care Res (Hoboken). 2014 Feb 4. doi: 10.1002/acr.22301. [Epub ahead of print]

Buskila, D, Neumann, L, Alhoashle, A, and Abu-Shakra, M. “Fibromyalgia syndrome in men,” Seminars in Arthritis and Rheumatism 30, no. 1 (2000): 47–51.

Caro XJ, Winter EF. Evidence of abnormal epidermal nerve fiber density in fibromyalgia: Clinical and immunologic implications. Arthritis Rheumatol. 2014 Apr 9. doi: 10.1002/art.38662. [Epub ahead of print]

Castro-Sánchez AM, Matarán-Peñarrocha GA, López-Rodríguez MM, Lara-Palomo IC, Arendt-Nielsen L, Fernández-de-las-Peñas C. Gender differences in pain severity, disability, depression, and widespread pressure pain sensitivity in patients with fibromyalgia syndrome without comorbid conditions. Pain Med. 2012 Dec;13(12):1639-47. doi: 10.1111/j.1526-4637.2012.01523.x. Epub 2012 Nov 21.

Cook D. B., Lange G., Ciccone D. S., Liu W. C., Steffener J., and Natelson B. H. Functional imaging of pain in patients with primary fibromyalgia, Journal of Rheumatology, 31, no. 2 (2004): 364–78.

Cooper, C and Miller, J. (2010). Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection. Healing Arts Press: Vermont

Craggs JG, Staud R, Robinson ME, Perlstein WM, Price DD.Effective connectivity among brain regions associated with slow temporal summation of C-fiber-evoked pain in fibromyalgia patients and healthy controls. J Pain. 2012 Apr;13(4):390-400.

Flodin P1, Martinsen S, Löfgren M, Bileviciute-Ljungar I, Kosek E, Fransson P. Fibromyalgia Is Associated with Decreased Connectivity Between Pain- and Sensorimotor Brain Areas. Brain Connect. 2014 Aug 7. [Epub ahead of print]

Gonzalez B, Baptista TM, Branco JC, Ferreira AS.Fibromyalgia: antecedent life events, disability, and causal attribution. Psychol Health Med. 2013 Jan 17. [Epub ahead of print]

Kosmidis ML1, Koutsogeorgopoulou L1, Alexopoulos H1, Mamali I1, Vlachoyiannopoulos PG1, Voulgarelis M1, Moutsopoulos HM1, Tzioufas AG1, Dalakas MC2. Reduction of Intraepidermal Nerve Fiber Density (IENFD) in the skin biopsies of patients with fibromyalgia: A controlled study.

Light KC, White AT, Tadler S, Iacob E, Light AR. Genetics and Gene Expression Involving Stress and Distress Pathways in Fibromyalgia with and without Comorbid Chronic Fatigue Syndrome.  Pain Res Treat. 2012;2012:427869. Epub 2011 Sep 29.

Staud R, Craggs JG, Perlstein WM, Robinson ME, and. Price DD, “Brain activity associated with slow temporal summation of C-fiber evoked pain in fibromyalgia patients and healthy controls,” European Journal of Pain (March 2008).

Dr. Sean Mackey, assistant professor of anesthesia at the Stanford University Medical Center, “An Update on Fibromyalgia.” https://www.youtube.com/watch?v=jtc2JARVpPw&feature=em-subs_digest-vrecs  (accessed 10-30-2014).

Mary Ann Moon, “ACR 2010 criteria for fibromyalgia critiqued.” Family Practice News Digital Network.http://www.familypracticenews.com/news/journals/single-article/acr-2010-criteria-for-fibromyalgia-critiqued/31131c4db6bf3642dd8748c0ad23f08b.html (accessed, 10-29-2014).

Frederick Wolfe. Fibromyalgianess. Arthritis Care and Research. DOI: 10.1002/art.24553 Article first published online: 28 MAY 2009. http://onlinelibrary.wiley.com/doi/10.1002/art.24553/full

Fibromyalgia: an INTERVIEW with Dr Frederick Wolfe, University of Kansas School of Medicine. Medical Net News. 

Frederick Wolfe, Daniel J. Clauw, Mary-Ann Fitzcharles,  Don L. Goldenberg, Robert S. Katz, Philip  Mease, Anthony S. Russell, I. Jon Russell, John  B. Winfiled, and Muhammad B. Yunus. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research, Vol. 62, No. 5, May 2010, pp 600–610. DOI 10.1002/acr.20140

Wolfe F, Brähler E, Hinz A, Häuser W. Arthritis Care Res (Hoboken).Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: Results from a survey of the general population. 2013 Feb 19. doi: 10.1002/acr.21931. [Epub ahead of print]

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011 Jun;38(6):1113-22. doi: 10.3899/jrheum.100594. Epub 2011 Feb 1.

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Update as of April 2015

"Adversity is only an obstacle if we fail to see opportunity."  

Celeste Cooper, RN

Author—Patient—Health Central Chronic Pain Pro —Advocate

New Website

Celeste’s Website: http://CelesteCooper.com

Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others.

More FM drug trials of the same, really? 1990 vs 2010 Criteria, which is it? My comment by Celeste Cooper

Am I in a fibrofog? Is this new drug trial for pain or for cognitive dysfunction in FM or both? The news reports are confusing. Is one right and the other wrong? They can’t both be right, can they? I went on a search. You can find the answer at the bottom on this blog.

New Fibromyalgia (FM) Clinical Trial Now Enrolling at Avail Clinical Research in Central Florida; Accepting M/F Patients with Fibromyalgia Age 18-59. June 30, 2013 Digital Journal, read here. 

There was no place to leave a comment. I would have because cognitive deficit is a primary symptom of fibromyalgia. Its effects are more extensive, including complete word loss, sudden onset dyslexia, severe and alarming short term memory loss etc. When we compare these cognitive affects with those experienced by people with chronic pain in general, there is a difference. My thinking is that some of these symptoms can also be attributed to hypothyroidism, and non-restorative sleep evidenced by loss of slow wave progression in sleep studies of fibromyalgia patients. This leads to the next question, "Will these factors be considered in participant screening? (More to come later). 

I found some red flag words - “mood disorders,” which can include biological psychiatric conditions, such as "bi-polar disorder" or "major depressive disorder," neither to be confused with a normal situation reaction of temporary anxiety or depression. These are terms that should not be used flippantly. As a chronic pain advocate and fibromyalgia expert, why?  What fibromyalgia patients experience is not different that the situational depression or anxiety that others with chronic pain experience. I will compromise that catastrophic thinking can sustain symptoms, but I am perplexed as to why anyone thinks it is any different in fibromyalgia when resent research suggested overwhelmingly that FM is a biological disorder. Are we to think that because migraine, interstitial cystitis, periodic limb movement and bruxism in sleep, and many of the comorbid conditions to FM should also be considered as "mood disorders?" Really?

This particular article suggests the 1990 criteria will be used to screen participants; however, that is not the case, which leads to more confusion. I suspect it is because the reporter saw that comorbid conditions are recognized, unlike what is suggested in the 2010 criteria. 

Accurate reporting is necessary. Read on to understand why this is a concern to me.

The next article just released. I was able to leave a comment:

New Fibromyalgia (FM) Clinical Trial Now Enrolling at Achieve Clinical Research in Birmingham, Alabama; Accepting M/F Patients with Fibromyalgia Age 18-70. July 1st, 2013 WatchListNews Press Release, here.

I hope this drug trial is targeted at a defective immune system versus chronic pain in general. Results of the FM/a Test have been overwhelming post research, and the follow up study in progress is ruling out the immune blood protein findings in FM in other rheumatological conditions. Otherwise, this study is on chronic pain in general. 

The number of Americans with chronic pain was amended from 116 million to an estimated 100 million, and the 2010 Preliminary Proposed criteria for diagnosing fibromyalgia has met with a great deal of criticism. The tool is confusing and does not require a physical exam. Many are boycotting this criteria because it is confusing and misleading. Since there is a blood test now for diagnosing FM, would that be a better place to start? It would certainly rule out any psychological illness that might otherwise be inaccurately diagnosed as FM.  The Wolfe, et al. criteria was amended in 2011 as "modified," and does NOT look specifically at the comorbid disorders you discuss. Instead, it looks at polysymtomatic syndrome as defined in the American Psychiatric Association diagnosis manual the DSM-5.

Side note: See “Fibromyalgianess is ALL in Our Head? My Correspondence with Dr Frederick Wolfe.”  Here.

I am highly suspicious that this drug trial is more of the same. While antidepressants and anticonvulsants medications help with chronic pain, the evidence has been underwhelming. Treating an immunological disorder with an SNRI, SSIR, [oops should have been SSRI] or anti-seizure meditation or a similar drug in those classifications is not going to improve patient outcome. Look at the prevalence of hypothyroidism in FM, would such drugs help with these symptoms? I suggest a really good review of the recent research regarding immunological factors, A-V shunting in the hands of FM patients, and the presence of small fiber neuropathy.

Last, but certainly not least, I saw no mention that patients would be screened for comorbid myofascial pain syndrome?  There is plenty of research and evidence to suggest that myofascial trigger points and attachment trigger points are present in ALL patients with chronic pain. The difference is investigating why latent MTrPs are easily activated in fibromyalgia when compared to the usual aggravating factors, spinal misalignment, posture, joint deformity, etc. I suspect the immunological effect of FM plays a role.

I suggest they change their study cohorts to people with chronic pain in general.

From PRWeb visit: http://www.prweb.com/releases/fibromyalgia/trials/prweb10886175.htm

OBJECTIVES:

The primary objective of the study is to assess the ability of a new drug to reduce Fibromyalgia pain. Specifically, this will be accomplished by evaluating the safety and efficacy of a 6-week treatment regimen with this new Fibro drug, to a maximum dose of either 5 mg or 20 mg, relative to placebo, in subjects with FM. Efficacy will be assessed on the basis of the baseline-adjusted weekly mean pain score obtained in the last week of treatment, as derived from subjects’ daily reports in an electronic diary. Daily pain scores will be reported on an 11-point numeric rating scale (Pain-NRS).

The secondary objective of the study is to assess overall improvement in fibromyalgia following treatment with a new Fibro drug relative to placebo. This will be assessed by:

•the Patient Global Impression of Change (PGI-C); and

•the Fibromyalgia Impact Questionnaire (FIQ) total score.

5. Diagnosis of primary fibromyalgia (FM) as defined by the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia

All blog posts and answers are not to replace medical advice.

Learn more about Celeste and her endeavors as patient, RN, educator and advocate at http://TheseThree.com

FMS and PTSD are comorbid conditions?

Hauser W, Galek A, Erbsloh-Moller B et al. 2013. Posttraumatic stress disorder infibromyalgia syndrome: Prevalence, temporal relationship between posttraumaticstress and fibromyalgia symptoms, and impact on clinical outcome. Pain. [Apr 2 Epub ahead of print].

“A link between fibromyalgia syndrome (FMS) and posttraumatic stress disorder (PTSD) has been suggested because both conditions share some similar symptoms. The temporal relationships between traumatic experiences and the onset of PTSD and FMS symptoms have not been studied until now. All consecutive FMS patients in 8 study centres of different specialties were assessed from February 1 to July 31, 2012. Data on duration of chronic widespread pain (CWP) were based on patients' self-reports. Potential traumatic experiences and year of most burdensome traumatic experience were assessed by the trauma list of the Munich Composite International Diagnostic Interview. PTSD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders IV symptom criteria by the Posttraumatic Diagnostic Scale. Age- and sex-matched persons of a general population sample were selected for controls. Three hundred ninety-five of 529 patients screened for eligibility were analysed (93.9% women, mean age 52.3years, mean duration since chronic widespread pain 12.8years); 45.3% of FMS patients and 3.0% of population controls met the criteria for PTSD. Most burdensome traumatic experience and PTSD symptoms antedated the onset of CWP in 66.5% of patients. In 29.5% of patients, most burdensome traumatic experience and PTSD symptoms followed the onset of CWP. In 4.0% of patients' most burdensome traumatic experience, PTSD and FMS symptoms occurred in the same year. FMS and PTSD are linked in several ways: PTSD is a potential risk factor of FMS and vice versa. FMS and PTSD are comorbid conditions because they are associated with common antecedent traumatic experiences.”

The rope is frayed. My comment:

  

I am uncertain as to why these researchers are suggesting that PTSD is a comorbid (overlapping) condition to fibromyalgia.  Fibromyalgia has been thought to be initiated by some traumatic emotional or physical event. However, Traumatic initiating events are not limited to emotional trauma; physical trauma is just as significant.  There was also a recent study that dismissed this all together. [Gonzalez, et al., 2013]. 

If the researchers are studying comorbid disorders, why are they not also considering hypothyroidism, bladder and bowel dysfunction, myofascial pain syndrome, lupus (SLE), ankylosing spondylitis, Raynaud’s, etc.?  Many fibromyalgia patients have no history of mental health disparities. So why does Dr. Hauser, and those who associate with him, keep wasting valuable research money on such ill fated endeavors? 

See Fibromyalgianess is ALL in Our Head? My Correspondence with Dr Frederick Wolfe here. 

Dr Hauser and Dr Wolfe co-authored another survey type study suggesting fibromyalgia meets the DSM-5 (American Psychiatric Assoscition diagnostiic manual) criteria.  I am not the only one with concerns.  See  Huffington Post article, Don't People in Chronic Pain Have Enough to Deal With? here.

Hypothesis = suggested probable cause to be proved or disproved.

If one is going to study a possible connection of comorbidity in fibromyalgia, they must at least consider ALL the suggested comorbid disorders, and they should conduct an extensive literature review before positing their hypothesis. It seems these researchers are bent on constructing studies to prove there is no other possibility. This is not research, at least not what I learned in college.  Study results are often unparalleled to the hypotheses. Researchers generally expect when they do not get the results they expect, they will need to form a new unexpected hypothesis. 

This study makes about as much sense as saying heart disease, which also has a degree of psychological stress,  is the result of post traumatic stress disorder (PTSD).   To suggest that disorders with many accompanying symptoms and comorbid disorders is nothing less than ludicrous. After all, heart disease can cause peripheral circulation symptoms, fatigue, blood pressure irregularities, heart arrhythmia, cold hands and feet, chest pain, exertional malaise, etc. Polysymptomatic, right?  

Post traumatic stress disorder (PTSD) is a very serious illness. "PTSD is a potential risk factor of FMS and vice versa." Is this to say that FM is a risk factor for PTSD? I am sorry, I do not make this connection. Am I alone in my thinking?