There are opposing discussions between clinicians, researchers, and stakeholders on the legitimacy and classification of fibromyalgia (FM) as a disease. In addition, because the fibromyalgia symptoms are many and don’t have conclusive diagnostic criteria, there is confusion despite the number of patients suffering.1 This is why myths exist regarding the disease.
What is fibromyalgia?
Fibromyalgia exists as a group of symptoms affecting the brain and body. It’s a chronic, widespread (all over the body) pain combined with lack of sleep, fatigue, and depression.1 Because of the variety of symptoms, recognition, and acknowledgment of this disease remain challenging.
Diagnosing fibromyalgia
Diagnosis of fibromyalgia is complex and is made by a primary care physician, with a referral to a specialist sometimes being secondary.1 Patient assessment is done using the Widespread Pain Index (WPI) and Somatic Symptom Scale (SSS).1,2 The WPI is a tool used to identify pain levels by bodily regions and the experience of symptoms and the SSS measures somatic symptoms like emotions and behaviours related to a condition .1
Previously part of the diagnosis of FM included an exam of tender points on the body, but this has not been a dependable method of diagnosis.1 To make matters more challenging for diagnosing FM, there are also no molecular identifiers for the disorder but magnesium levels and N-methyl-D-Aspartate seem to be involved.1,2
Myths versus truths
Myth: Fibromyalgia is not an actual health condition.
In 1994 the World Health Organization (WHO) classified fibromyalgia as a disease of the musculoskeletal system and connective tissue.1 Fibromyalgia classification also included being a disorder “to imply the existence of a clinically recognizable set of symptoms or behaviors associated in most cases with distress and interference with personal functions”.1
Myth: Fibromyalgia is just a symptom of depression.
Many who suffer from depression also experience physical pain. Many who experience physical pain also suffer from depression. These associations suggest that fibromyalgia is just a symptom of undiagnosed depression.
However, not every individual with FM has depression, and not every person who is depressed has widespread chronic pain.1 German guidelines state that FM and undiagnosed depression are not interchangeable”.1
Myth: Fibromyalgia is a somatic “all in your head” issue.
Fibromyalgia symptoms are often worsened under times of great stress. This stress-induced response led to psychosomatic medical specialists diagnosing FM as a “persistent somatoform pain disorder” (SSD) and this is why the Somatic Symptom Scale is often used for diagnosis and research purposes.1,2 Somatic means a heavy focus on symptoms, making the physical experiences worse. As a result, the symptoms are considered clinically relevant, but the physical experiences are hard to pinpoint or diagnose.
The American Psychiatric Association recently replaced the “pain disorder” category with SSD.1 Recent publications have also classified FM as an SSD.1 That being so, a minority of people living with FM are not satisfied with the criteria for SSD.1 German guidelines also affirm that FM and persistent somatoform pain disorder differ.1
Myth: Fibromyalgia is a neurological disease.
Claims have been made that fibromyalgia is a neurological disease. However, several pathology findings are not found in all patients who meet the criteria for FM.1 However, neuropathic pain is a symptom often seen in those with FM so neurology should still be explored.2
Myth: Fibromyalgia is a middle-aged woman’s complaint.
Fibromyalgia affects many people, although women are more likely to consult with their physicians which may be why more women seem to be affected. Unfortunately, because of the association of FM being a woman’s disease, physicians also sometimes neglect to consider FM as a diagnosis for men.1 With these imbalances in data, the idea of FM being a woman’s complaint is no wonder.
Myth: Fibromyalgia is an unhelpful diagnosis.
Concerns have been raised in the fields of psychiatry and pediatrics that the diagnostic label of fibromyalgia neglects psychosocial symptoms and can be harmful to patients.1 Guidelines, however, recommend using the FM diagnostic label.
In consensus, is that patients should understand the biopsychosocial model for FM, whereby biological factors and psychosocial factors both play a part in FM symptoms.1 This is to decrease anxiety, which accompanies chronic pain, and to minimize the repetition of unnecessary diagnostic tests and unnecessary drug treatments.1
Myth: All pharmaceuticals for mental disorders are effective for fibromyalgia symptoms.
Pharmaceuticals for mental disorders are commonly used with fibromyalgia patients. However, evidence, especially those used in managing mental health disorders, is lacking to treat FM symptoms.1
Myth: Drugs for fibromyalgia are helpful as long as their FDA-approved.
Drugs the FDA has approved don’t always mean they are effective for everyone, especially with such complex disorders as fibromyalgia. In pre-approval studies, for example, only a small number of participants reported a clinically relevant reduction in pain.1 Most study participants didn’t experience relevant pain relief or ended the therapy due to adverse events.1
Myth: Psychological therapies cure fibromyalgia.
Cognitive behavioral therapy (CBT) is one psychological therapy commonly used to help patients manage their symptoms and enhance their quality of life.1 Unfortunately, CBT wasn’t better than other therapies like antidepressants and analgesic medicines concerning the quality of life or “somatic and psychological symptoms”.1
Conclusion
As a result of the confusion in diagnosing, classifying, and treating fibromyalgia, many myths exist. Research supports FM as a valid disease. The recognition of FM will help promote researchers and clinicians to understand the pathophysiology and improve treatments.1
References
- Häuser W, Fitzcharles M. Facts and myths pertaining to fibromyalgia. Dialogues in Clinical Neuroscience. 2018;20(1):53-62. https://doi.org/10.31887/DCNS.2018.20.1/whauser
