Looking at fibromyalgia differently – An observational study of the meaning and consequences of fibromyalgia as a dimensional disorder 2022 Wolfe et a

Highlights

• Fibromyalgia represents a convenient point, defined for clinical and heuristic purposes, on a continuum of physical and psychosocial distress.

• Pain and non-pain variables change linearly over the full range of the fibromyalgia symptom continuum (polysymptomatic distress (PSD) scores.

• We cannot find evidence of differences in the quality and nature of pain and symptoms across the diagnosis dividing line.

• There is substantial overlap in important clinical symptoms at the interface between fibromyalgia (+) and fibromyalgia (-) negative categories.

• Comparison between highly symptomatic fibromyalgia subjects and “healthy controls” is not a valid measure of pain centralization, as it is strongly influenced by a multitude of non-central factors and omits most people with pain

• A fibromyalgia continuum severity score (polysymptomatic distress (PSD) offers much more useful information than fibromyalgia positive and negative categories.

Abstract

Objective
Despite data showing that fibromyalgia can be represented as a dimensional disorder, almost all assessments treat fibromyalgia as a dichotomous categorial disorder; and research shows that agreement between community diagnosis of fibromyalgia and fibromyalgia criteria is poor. We investigated the validity of FM as a discrete disorder by exploring the relationships of categorical fibromyalgia, the polysymptomatic distress (PSD) scale, and clinical variables.

Methods
In a databank of 33,972 rheumatic disease patients, we studied the categorical diagnosis of fibromyalgia, the PSD scale separately and divided into severity groups, measures of widespread pain, as well as somatic syndrome questionnaires like the Patient Health Questionnaire-15 (PHQ-15), and clinical pain, global, HAQ disability and quality of life scales (EQ-5D).

Results
Clinical and demographic variables became more abnormal with increasing PSD score groups, indicating substantial increase in symptoms and pain. The changes across PSD categories were linear and large. When we compared FM- (PSD 8-11) with FM+ (PSD 12-18) patients we found considerable overlap in scores for pain, HAQ disability, patient global, PHQ-15, psychological status, and other variables. Somatic symptom scores were highly correlated with PSD (r=0.718). There was no evidence of a differential pain effect that was present in FM+ but not FM- subjects.

Conclusion
Fibromyalgia is more accurately considered a dimensional than a dichotomous disorder. There is vast variability among fibromyalgia positive and negative cases that is governed by the strong and linear relationships between the dimensional PSD scale and clinical variables. The PSD scale provides measurements of the fibromyalgia dimension that support and enlighten categorical fibromyalgia and are an effective tool to measure clinical status and changes. Whatever the mechanism of the pain and symptom increase in fibromyalgia, it appears to operate over the entire fibromyalgia symptom dimension, not just in those with categorical fibromyalgia.

Open access, https://www.sciencedirect.com/science/article/pii/S0049017222001962

 

It was always obviously wrong to make syndromes out of single common symptoms of illness, especially based on primary symptoms that often aren't even present in the patient. Somehow making this mistake has lead to making even worse mistakes. It's seriously amazing how people can hold in their heads the idea of patients with many symptoms having more symptoms than the single-symptom syndrome label that was applied to them, but are unable to see the problem. Absurd.

This whole disaster is over medicine's exclusive reliance of differential diagnosis. There aren't always clear differences, sometimes they're simply out of reach of current technology. But it's the way it's misused that is catastrophic where it fails, because it does not recognize the possibility of failure, so much that the most common problems in medicine are pretty much the least scientifically studied.

Those highlights are a doozy of pseudoscience and pseudointellectualism.

 

The 2016 FM diagnostic instrument (https://www.fmauk.org/files/acr2016FibroCriteria.pdf) is simple enough, and is referenced in the article by Woolfe, F; et al. This is the main value of the article for me, seeing this instrument, a supposed improvement over the 2010 ACR (American College of Rheumatology) criteria. I don't know as much about the differences as I should.

As with ME's various diagnostic/research-related criteria versions, some of the FM criteria of the past, like tender points, were standardized to be used in doing research only, basically.

I perused the article as Dr. F. Woolfe has been quite negative in the past about employing a diagnostic term ("fibromyalgia") for the sufferers. So, I am sensitized to reading anything by him.

Much earlier in his career, he had expressed extreme doubt about the utility of giving patients the diagnosis of FM, in that it has harmful effects (?) on them. It certainly helped me research my condition, contact researcher/clinicians, get valuable advice, and contact others for support.

Here, he and his colleagues seem to be refining the symptoms and categories in a downward fashion so fewer patients qualify for the diagnosis.

But I'll have to reread it carefully, if I can stand to.

 

Wolfe has previously stated that he believes Fibromyalgia is psychosomatic. I believe Fibromyalgia is a diagnosis best avoided, especially if you already have an ME diagnosis.

 

There is a fascination with self-reported questionnaires to interpret the symptoms of patients. I am not sure I can handle filling out one more questionnaire.

I very much agree with you.