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

Web MD Slideshow: A Visual Guide to Fibromyalgia: Six important key points.

Web MD Slideshow: A Visual Guide to Fibromyalgia, here.  

#1

Tender point exam is still suggested. [This is a very important part of the physician or nurse practitioner assessment. Omitting a physical exam, as done in the 2010 preliminary or 2011 modified criteria adopted by the American College of Rheumatology, is neglectful. See my blog on Sharecare here.

#2

There’s one lab test that can check for fibromyalgia. It measures the levels of proteins in the bloodstream and can help confirm a fibro diagnosis.

See news here.

Information on test here. 

#3

Exercising just three times a week has also been shown to relieve fatigue and depression. But it's important not to overdo it. [Do’s and Don’ts of exercise in fibromyalgia and chronic myofascial pain, Cooper and Miller, 2010, here]

#4

Nutrition. [An important piece suggested by Cooper and Miller. About Cooper and Miller, here.] 

#5

Massage. [Known to help painful shortened muscle fibers, trigger points, and return to normal resting length, Trigger points are discussed by Cooper and Miller, 2010, here.]

#6

Therapies. We discuss these and more in our book (Cooper & Miller, 2010). Learn more here.

 

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

 

You can find Celeste and more information on dealing with, and managing, chronic pain and comorbid conditions on her website http://TheseThree.com

 

Sneak peek #4 - Virtual Book Tour, SUMMER DEVOTIONS - Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain Series

Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain Series

SUMMER DEVOTIONS – Virtual Book Tour

~ • ~ • ~ • ~ • ~ • ~

Published on June 2, 2013,

Our Author ranking for all books is in the top 18%

~ • ~ • ~ • ~ • ~ • ~

Sneak peek #4

“Broken Body, Wounded Spirit offers a unique blend of the philosophical and the practical. Structured as a “book of days,” the authors provide a combination of daily spiritual advice that settles the heart, as well imminently practical ways to deal with the physical hardships imposed by chronic pain. This is a book that will prove invaluable to anyone seeking to re-establish the balance of mind and body in the face of long-term illness.”

~Erica Verrillo, author Chronic Fatigue Syndrome: A Treatment Guide, 2nd Edition, and the Phoenix Rising Trilogy

Read more here.

Celeste Cooper and Jeff Miller have provided an arsenal to fight this dragon that threatens energy, growth, and healing.  By focusing on each summer day, the authors send their readers on a personal journey of mindfulness and self awareness, allowing the reader to restructure personal experience on how pain is perceived.

Day Forty-Five

By identifying the difference between being alone and loneliness, you will learn to answer this important question, “What can I do today to balance my alone time and my time with others?” on day forty-five.

Behind these eyes there is love, for if I fail to recognize the beauty of all humankind;

I am not able to forgive myself.   

~Celeste

Celeste Cooper is a retired, advanced trained, registered nurse. She is lead author of several books, contributing author, and freelance writer. She volunteers as health expert at Sharecare, advocate, and participant in the Pain Action Alliance to Implement a National Strategy.  Through her own trials, she has learned to transform her perception of pain, and it has become her life's mission to share what she has learned with others who share this sometimes arduous journey. She by no means claims to be cured of chronic pain, but she is motivated to live her best life by not giving in to what she often calls the dragon. 

Paperback now available here.

Kindle e-book available here.   (Don’t have Kindle? Get a free app here)

We hope you will help us out by going back to Amazon to say a few words, rate the book, and let us and our other readers know what you think.  Just scroll down the page just past “More About the Author” and click on the:

Write a Customer Review Button

Or click

HERE

The book will be available at all major online retailers soon.

~ • ~ • ~ • ~ • ~ • ~

Other books by Celeste Cooper and Jeff Miller:

C. Cooper and J. Miller. Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain. [ Series]. (Blue Springs, MO, ImPress Media, 2012 – 2014). Read more about Fall Devotions here. 

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

Read more here.

~ • ~ • ~ • ~ • ~ • ~

Dear Dr. Albrecht, Dr. Behm, Dr. Ge Hy, and Dr. Oaklander - Are these studies related?

RE:
Is there a possibility that the small-fiber polyneuropathy explains palmer AV Shunt in FM?
Could the disruptions be due to immune disruption?
How would this affect sustenance of MTrP treatments?

Dear Dr. Albrecht, Dr. Behm, Dr. Ge Hy, and Dr. Oaklander,

[Dr. Oaklander], is there a possibility that small-fiber polyneuropathy, which you and your team found in fibromyalgia, contributes to the enervation of arterioles and venules (AV shunt) in the palms of fibromyalgia patients causing them to behave erratically, as found by Dr. Albrecht’s team? Personally,  I have always felt that Raynaud’s and symptoms reported that are compatible with levido reticularis have more than a casual connection to fibromyalgia. 

This leads me to the next question, “Could this be occurring due to the unique immune pattern found in the study led by Dr. Behm?”

In my thinking, two of the studies, Dr. Albrecht and Dr Oaklander and their team, complement one another. Can we look forward to more studies regarding this possible connection?

Dr. Oaklander, you suggest that treating polyneuropathy might improve symptoms, so my next question is to Dr. Albrecht, “Could treating polyneuropathy improve the A-V shunt issue and thereby improve many symptoms having to do with body temperature control improving feedback to the brain?”

In my mind, a third possibility could be the suspected immune factor as studied by Dr. Behm and his team. Could finding and treating immune disease improve all of the above, or is it unrelated?” What is your thinking on this Dr. Behm?

One last question, “Could these disruptions explain why myofascial pain syndrome, thought to be a major pain contributor to many chronic pain disorders, be so difficult to control as a comorbid condition in fibromyalgia?” Generally, with sports injuries MTrPs are easily treated, but even a slight breeze can cause latent MTrPs in fibromyalgia patients to light up like a Christmas tree. Dr. Ge Hy, What are your thoughts on this? Could the findings of these other three teams have an effect on MTrP histology in fibromyalgia in particular?

I want to personally thank you, and I am certain I speak on behalf of all fibromyalgia patients, for all the research you are doing individually and collectively. It is validating and gives those of us who live with fibromyalgia hope. Many do not understand the impact this disorder has on a persons life.  

You know you have fibromyalgia when people say to you, 

"Nobody could have all those things at one time."

As a fibromyalgia expert at Sharecare.com, author, advocate and patient, I am interested in your thinking, and I know those I serve would be delighted to have a direct reply.

Thank You.

Sincerely, Celeste Cooper, RN


Studies and articles:

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] Pubmed abstract here.

CONCLUSIONS:

“The excessive sensory innervation to the glabrous skin AVS is a likely source of severe pain and tenderness in the hands of FM patients. Importantly, glabrous AVS regulate blood flow to the skin in humans for thermoregulation and to other tissues such as skeletal muscle during periods of increased metabolic demand. Therefore, blood flow dysregulation as a result of excessive innervation to AVS would likely contribute to the widespread deep pain and fatigue of FM. SNRI compounds may provide partial therapeutic benefit by enhancing the impact of sympathetically mediated inhibitory modulation of the excess sensory innervation.”

ARTICLE, Women with Fibromyalgia Have A Real Pathology Among Nerve Endings to Blood Vessels, at Integrated Tissue Dynamics. This is a fantastic article that explains what happens in an easy to understand analogy. See entire article here. 

“Scientists at Integrated Tissue Dynamics (Intidyn) and Albany Medical College have made a major discovery that should provide a more certain diagnosis of fibromyalgia, significant insight into the source and symptoms of the disease, and new strategies for its prevention and treatment. The Albany Med and Intidyn research team - headed by neurologists Charles Argoff, MD, and James Wymer, MD PhD and neuroscientists Phillip Albrecht, PhD, and Frank Rice, PhD - discovered that the skin in fibromyalgia patients has a major pathology involving nerve endings to a key type of blood vessel called arteriole-venule shunts… arteriole-venule shunts play a major role in the proper distribution of blood flow throughout the body, and the discovered pathology involving the nerve endings to the shunts provides a logical explanation for the widespread deep pain and fatigue symptomatic of fibromyalgia.

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. Pubmed abstract here. 

CONCLUSIONS:

“The cytokine responses to mitogenic activators of PBMC isolated from patients with FM were significantly lower than those of healthy individuals, implying that cell-mediated immunity is impaired in FM patients. This novel cytokine assay reveals unique and valuable immunologic traits, which, when combined with clinical patterns, can offer a diagnostic methodology in FM.” 

MY COMMENT:

The role of cytokines in FM has been studied over more than a decade.  I have never had a doubt regarding my own body that there is something askew in the immune system that accounts for the co-existence of particular disorders. Plasma levels have been consistently low, but not considered low enough to be significant.  This research is looking at specific cytokines in specific cells, in specific ways, and the results will no doubt lead research in the right direction.  I truly feel a bio-marker could be around the corner. Cc

Ge HY, Nie H, Graven-Nielsen T, Danneskiold-Samsøe B, Arendt-Nielsen L. Descending pain modulation and its interaction with peripheral sensitization following sustained isometric muscle contraction in fibromyalgia. Eur J Pain. 2012 Feb;16(2):196-203. doi: 10.1016/j.ejpain.2011.06.008. Pubmed abstract here. 

CONCLUSIONS:

“Descending pain modulation shifts from descending inhibition towards descending facilitation following muscle nociception in FM. Peripheral mechanical hyperalgesia and descending facilitation counterbalance the effect of descending inhibition in FM.”

MY COMMENT:This result should be no surprise in light of the stress contraction puts on a muscle when it has myofascial trigger points present. Cc

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] Pubmed abstract here. 

CONCLUSION:

“These findings suggest that some patients with chronic pain labeled as "fibromyalgia" have unrecognized small-fiber polyneuropathy, a distinct disease that can be objectively tested for and sometimes definitively treated.”

ARTICLE: Small-Fiber Polyneuropathy Found in Fibromyalgia Patients. See entire article at Examiner.com, here.

 “Finally with the FM patients had a reduction in dermal unmyelinated nerve fibre bundles was found in skin samples of patients with fibromyalgia syndrome compared with patients with depression and with healthy control subjects, whereas myelinated nerve fibres were spared.”

Sneak peek #3 - Virtual Book Tour, SUMMER DEVOTIONS - Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain Series by Celeste Cooper

Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain Series

SUMMER DEVOTIONS – Virtual Book Tour

~ • ~ • ~ • ~ • ~ • ~

Published on June 2, 2013,

Our Author ranking for all books is in the top 18%

~ • ~ • ~ • ~ • ~ • ~

Sneak peek #3

~ Barbara Ficarra, RN, BSN, MPA is founder of Healthin30.com, award-winning broadcast journalist, featured writer for The Huffington Post and health educator and member of the editorial advisory board at Sharecare.com.

Read more here.

Imagine a dragon breathing its inferno, and then watch it engulf everything in its path. Chronic pain acts like that; it is a raging fire that devours logical thinking. It incinerates comfort, companionship, dreams and goals. When pain dominates, it’s a force that must be challenged.

Day Forty

Our language holds power in the choice of words both in meaning and symbol.  We have grown accustomed to overstatement and barely notice the exaggeration that absolute terms like “never”, everyone”. “nothing”, “always” impose on our perceptions.  On a subconscious level these words are taken literally and our minds change our experience to fit the new definitions.  Hence we suffer so much more than necessary.  Literally, it only seems like “always” or “never”.  Bringing digital exactitude to our self talk is exchanging conflated hurting terms for precision power terms. “Rarely”, “frequently”, “some” or “few” are more honest and much less damaging.

“Always avoid never and never use always.”

~ Jeff

Dr. Jeff Miller is a counseling psychologist in private practice.  Among other interests, Jeff values working with patients with chronic pain and illness.

Paperback now available here.

Kindle e-book available here.   (Don’t have Kindle? Get a free app here)

We hope you will help us out by going back to Amazon to say a few words, rate the book, and let us and our other readers know what you think.  Just scroll down the page just past “More About the Author” and click on the:

Write a Customer Review Button

Or click

HERE

The book will be available at all major online retailers soon.

~ • ~ • ~ • ~ • ~ • ~

Other books by Celeste Cooper and Jeff Miller:

C. Cooper and J. Miller. Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain. [ Series]. (Blue Springs, MO, ImPress Media, 2012 – 2014). Read more about Fall Devotions here. 

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

Read more here.

~ • ~ • ~ • ~ • ~ • ~

Sneak peek #2 - Virtual Book Tour, SUMMER DEVOTIONS - Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain Series

Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain Series

SUMMER DEVOTIONS – Virtual Book Tour

~ • ~ • ~ • ~ • ~ • ~

Published on June 2, 2013,

Paperback version ranks in top 1% today on Amazon

(Paperback being offered at 33% discount)

Kindle version ranks in top 9% in ebooks category

~ • ~ • ~ • ~ • ~ • ~

Sneak peek #2

"A unique, useful and highly inspirational book for anyone with chronic pain... or any chronic illness... or any challenging life situation. In short, this is a book that EVERYONE should own a copy of … and pick up and read daily."

~ Kevin White, MD, PhD, Multiple award-winning author of Breaking Thru the Fibro Fog: Scientific Proof Fibromyalgia Is Real

Read more here.

Summer Devotions is the second of a four book series, Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain. It is a tribute to everyone committed to living a fearless life despite the road blocks caused by living with chronic pain and illness.

Day Seventy-two 

Did I overdo?

We must do an assessment of overdoing, doing enough, sleep, and aggravating or alleviating factors related to our pain. On Day Seventy-two of Summer Devotions, we provide a helpful tool for doing all these things to help answer your questions.

As I navigate through life with invisible illness, turning tragic into triumph,

 I accept that some days, despite doing everything right, I do not prevail, and that's OK.    

~ Celeste

 

Celeste Cooper is a retired, advanced trained, registered nurse. She is lead author of several books, contributing author, and freelance writer. She volunteers as health expert at Sharecare, advocate, and participant in the Pain Action Alliance to Implement a National Strategy.  Through her own trials, she has learned to transform her perception of pain, and it has become her life's mission to share what she has learned with others who share this sometimes arduous journey. She by no means claims to be cured of chronic pain, but she is motivated to live her best life by not giving in to what she often calls the dragon. 

Paperback now available here.

Kindle e-book available here.   (Don’t have Kindle? Get a free app here)

We hope you will help us by going back to Amazon to say a few words, rate the book, and let us, and our other readers, know what you think.  Just scroll down the page just past “More About the Author” and click on the:

Write a Customer Review Button

Or click

HERE

The book will be available at all major online retailers soon.

~ • ~ • ~ • ~ • ~ • ~

Other books by Celeste Cooper and Jeff Miller:

C. Cooper and J. Miller. Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain. [ Series]. (Blue Springs, MO, ImPress Media, 2012 – 2014). Read more about Fall Devotions here. 

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

Read more here.

~ • ~ • ~ • ~ • ~ • ~

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?