Is Fibromyalgia a Real Disease?

If you are a patient suffering from fibromyalgia syndrome (FMS), you face several challenges. Not only are you suffering from painful symptoms, but you may find attitudes of incredulity from your family, friends and, worst of all, maybe even your doctor. Can anything be much worse than being questioned about the validity of your health problems or what you are experiencing? Does it not cause greater confusion, raise inner doubts and maybe drive you towards depression when everyone questions your “problems”? Is it ever helpful when you are told fibromyalgia is not a “real” disease? Does it do you any good to feel this may “all be in your head?” Of course not! Yet, this is a controversy that has fibromyalgia sufferers have dealt with for years – the issue of whether fibromyalgia is really a disease.

The arguments or discussions on fibromyalgia alternate between emotional disbelief and scientific evidence. A good place to start is with the detractors participating in what Wolfe refers to as the “fibromyalgia wars”[1], which Hall simply calls the fibromyalgia controversy.[2] It is a bitter controversy in which those who deny the validity of fibromyalgia as a disease or distinct medical condition are quite adamant about their opinions.

For example, the specific statement of Ehrlich gives insight into the depth of the controversy.[3] He believes fibromyalgia exists only because a doctor says it does. He, therefore, calls it an “iatrogenic syndrome” indicating its origins lie in a medical diagnosis or medical treatment rather than an actual medical problem. In other words, the doctor says you have it,  so you do. According to Ehrlich, the common symptom of pain has become a “remunerative industry” fueled by various organizations and groups who can use the diagnosis to make money. The diagnosis of fibromyalgia is used as an explanation where no other exists for someone who has pain.

Ehrlich is followed by others such as Hadler. Hadler describes fibromyalgia as an individual’s choice or a personal decision. He sees it as a way for people, who are over stressed and too worn out to cope and can’t find a medical justification, to justify the way they feel physically and mentally. It is, like Wolfe will declare, a part of the overall psychosocial construct for coping resulting from modern day life.

Wolfe notes several reasons why he does not believe FMS is a bona fide disease. These include the following:

  • In its relation to pain, Wolfe believes fibromyalgia is merely an extension of pain and related stresses due to other causes.  He does not believe fibromyalgia is an expression of a separate and distinct medical condition from the various other medically identified chronic pain disorders. Fibromyalgia is, therefore, simply a manifestation or continuation of an already existing medical problem. It is not a separate health issue – disease or syndrome.
  • Wolfe remarks that there is no discernible and explicit or precise pathological process that can be identified. In other words, FMS seems to lack a specific pathway or etiology.
  • Fibromyalgia is described by Wolfe as “socially constructed.” In agreement with Ehrlich, Wolfe believes it is society, the medical profession, pharmaceutical companies, professional organizations and associations and even government groups that are responsible for not only the labeling but also the continuance of fibromyalgia as a disease.

Wolfe goes one step further in his dismissal of FMS as being a valid disease. This concerns treatment. He states that since medical professionals seem to have made little progress against combating the disease, it must not be a true disease.  This is not a valid argument according to Harth and others since medical problems such as diabetes, cancer and other recognized medical conditions have also been met with a lack of treatment success despite years of recognition. In fact, a number of medical researchers and medical professionals, including Harth, have objected to this viewpoint.[4]

One of the main objections many people have with fibromyalgia is that there is no objective evidence of a disease. No lab test, x-ray, CT, MRI, or physical exam finding shows any abnormalities to the doctors. Pain is entirely subjective and thus, the doctors can only go off of the patient’s symptoms. This leads to skepticism from many in the medical field regarding the diagnosis.

So what are the arguments for the validity of FMS as a disease?

Although fibromyalgia is identified as a syndrome – a medical issue consisting of multiple symptoms and conditions such as chronic pain, sleep difficulties, cognitive impairment, several tender points and serious fatigue – many researchers believe the syndrome to be both real and a condition not to be grouped with rheumatoid arthritis, psychological issues or strictly somatic problems. Fortunately for many patients who suffer from fibromyalgia, there are a number of doctors who believe it is a valid health problem. This has become true even for several doctors who formerly considered a fibromyalgia diagnosis to be a last resort for doctors who could not diagnosis any other medical condition or who believed patients were claiming symptoms as an excuse for being prescribed drugs to treat their unknown depression, fatigue and/or pain.[5]

The reasons doctors have changed their minds may vary. Some, such as Fitzcharles and others, describe it as a belief the fibromyalgia source will be found in the “neurological domain with evidence of dysregulation of pain processing.” [6] Harth supports the diagnosis as being real as do many other physicians. In well-stated arguments in contradiction to those put forth by Wolfe, Harth states that saying fibromyalgia is “socially constructed” implies the disease does not have any physiological basis. In fact, the opposite seems to be true based on research to date. There is scientific evidence that clearly verifies physical manifestations, trigger points and other factors related to fibromyalgia. As Sarkozi reports, individuals who have FMS demonstrate what is called a malfunction or abnormality affecting their ability to synthesize pain properly. It is what Sarkozi refers to as “central sensitization-driven abnormal pain-processing.”[7] This can be seen in functional MRI studies where FMS patients and those without FMS were both exposed to a minor pain. The FMS patients had signficiantly more brain activity on the MRI than the non-FMS patients. This supports the theory that FMS patients respond to pain differently than those people without FMS.

One day, the controversy concerning fibromyalgia will be resolved through research. Until it is resolved, those who have fibromyalgia will probably continue to be experience derisive comments, disparaging remarks and expressions of disbelief. Sufferers will continue to undergo stigmatization by many in the medical profession, as well as friends, fellow workers and family members. Many fully believe that continued medical research will legitimize fibromyalgia as a medical condition or disease and lead to specific treatments.

References

[1] Wolfe F (2009). “Fibromyalgia Wars.” J Rheumatology, 36(4):671-8.

[2] Hall, MB (2009). The Fibromyalgia Controversy. Amherst, NY: Prometheus Books.

[3] Ehrlich, GE (2003). “Pain is real; Fibromyalgia Isn’t.” Journal of Rheumatology, 30 (8):1666-1667.

[4] Harth, M; and Nielson, W (2009). “War Is Over. Give Peace a Chance (with apologies to the late John Lennon).” The Journal of Rheumatology, 36(12): 2837-2838.

[5] Shaw, G (2009). “Fibromyalgia: Is Fibromyalgia Real?” Neurology Now, 5 (5):29-32.

[6] Fitzcharles, MA; and Yunus, MB (2011). “The Clinical Concept of Fibromyalgia as a Changing Paradigm in the Past 20 Years.” Pain Res Treatment, 2012 (2012):184835.

[7] Sarkozi, J (2009). “Fibromyalgia and the Fallacy of Pain from Nowhere.” J Rheumatol, 36(12):2836-2837.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015