In attempting to unravel fibromyalgia (FM), Drs Winfried Häuser and Mary-Ann Fitzcharles [2018] have succeeded only in tying more circular knots.

On the one hand, they claim: “FM is a heterogeneous condition with variability in symptoms and symptom intensity, psychophysiologic responses to stress, patterns of coping and outcomes with treatment.” This heterogeneity – in presentation, diagnosis, and response to intervention – is enshrined in the 2016 revisions to the 2010/2011 FM diagnostic criteria [Wolfe et al. 2016], that depend on arithmetic summing of weighted subjective symptoms. There is no gold standard.

On the other hand, they claim: “FM … may co-exist with other conditions.” They further blur any possible boundary of FM by discerning four (!) subgroups, ranging from occurrence without any other illness (i.e. primary FM), to being associated with “mental health problems”, other pain conditions, or another disease (i.e. secondary FM).

When the logic of these two statements is combined, we have an arbitrary aggregate of symptoms that can coexist with “anything else”, including “other pain conditions”. The result is a splendid – but unfortunate – example of a tautology – a proposition that can be shown to be true only because it includes all possibilities, a fallacy in clinical reasoning that we exposed 25 years ago [Cohen & Quintner 1993].

So now, given the wholly subjective nature of the revised criteria for “FM diagnosis”, identification of “non-FM” in people experiencing pain is even more remote.

Drs Häuser and Fitzcharles go on to cloak the tautology in metaphor – “the pain experience of FM tends to flow over and around the body in a mist-like fashion” – which may be seen as simultaneously insulating their construct and shrouding it in impenetrability. We suppose that is consistent with their next metaphor, as indeed, with apologies to the actress Jane Fonda, “FM is a chameleon, the condition everyone wants it to be”. [https://www.brainyquote.com/quotes/jane_fonda_582725?src=t_chameleon]

John Quintner & Milton Cohen

References:

Cohen ML, Quintner JL. Fibromyalgia syndrome, a problem of tautology. Lancet 1993; 342: 906-909.

Häuser W, Fitzcharles M-A. Unravelling fibromyalgia. https://bodyinmind.org/fibromyalgia/ Accessed 23rd March 2018.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, Mease PJ, Russell AS, Russell IJ, Walitt B: 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 46:319-329, 2016