Yeah, that’s the definition of epilepsy. The difference is that epilepsy can be confirmed in a patient without ever actually speaking to the patient. It can be diagnosed in a 4 month old infant. It’s objectively observable. Fibromyalgia can only be diagnosed by patient-reported symptoms, which makes it a lot harder to study. It might be a psychological problem, or a physical problem that we just aren’t looking at the right physical indicators for.
The two of you are in direct conflict here on what would seem to be a point of fact. I mean, either there are diagnostic signs, or there aren’t. I’m curious about this question because I dated a woman diagnosed with fibromyalgia, but the curiosity is sort of idle because I don’t anymore. She definitely had issues in her childhood, so could fit the profile that ISofT mentioned.
Or both. Plus several other things as well, because all people with Fibromyalgia have in common is a symptom. Both Fibromyalgia and Epilepsy shouldn’t be thought of as diseases or conditions. They’re labels for people with common recurring symptoms with unknown causes. The only difference is that it’s alot easier to see a siezure than to tell if someone is actually in pain. Epilepsy could be 50 different unrelated conditions and Fibromyalgia could be 75. At our current level of knowelge we have no way of knowing.
Not true. There’s like 40 different kinds of epilepsy. Being an epileptic means you have seizures. I have seizures from a head injury - we know the cause - but I’m still an epileptic.
I’m an EMT student, not a doctor. All I can tell you is whats in my textbook. Head injury is listed as one of the non-epiepsy causes of seizures. So by my textbook’s definition you’re not an Epileptic. By EMS standards you’ld be a person with recurring seizures due to past head truama. Your doctor may disagree. If so I would go with their opinion.
I’m extremely glad that your diagnosis turned out to be inaccurate and that you no longer experience the symptoms that led to that diagnosis.
That being said, you comment shows both a complete lack of empathy and a flavor of arrogance the world could well do without.
Please consider the possibility that your experience is not the universal rulebook which dictates the validity of all other people’s experience. There are those who experience the symptoms of fibromyalgia who are not wallowing in self-pity and narcissism.
The inability to accept that others may in fact suffer from a painful, debilitating malady because you ended up not suffering from a painful, debilitating malady indicates that while you may have stopped wallowing in self-pity, you haven’t quite made it out of the narcissism.
This is exactly the question that I’m after.
Just because a group of doctors (and/or medical researchers) get together and agree to define a disease called fibromyalgia on the basis of a set of symptoms and physical findings, does not (necessarily) make it a “real”, physical, “objective” disease (in the same way as, say, pneumonia or lung cancer). Unlike pneumonia or cancer, there is no diagnostic test which if positive proves the diagnosis of fibromyalgia. There is no agreed explanation on the pathogenesis of fibromyalgia (i.e. how it comes about, what the fundamental nature of the disease is). Treatment is essentially symptomatic and runs a gamut that includes exercise, behavioural counseling, mild pain relievers and anti-inflammatories, non-traditional pain relievers (e.g. gabapentin, amitiptyline, etc.), older anti-depressants, newer anti-depressants, and even various herbal and complementary therapies, i.e. there is no specific treatment. Taken together, the features in this paragraph don’t make a strong case for a “physical” disease (IMHO).
To paraphrase Bricker, “how does fibromyalgia differ from something that’s all in the head”?
(Please note that some “all in your head” diseases, e.g. schizophrenia, are definitely still diseases. However, we have a reasonable sense of their pathogenesis and we understand their biochemical basis. They even have effective, specific therapies. All of these things, of course, are not really the case for fibromyalgia.)
This is by far the best possible response to the throwaway comment you were responding to. In all seriousness, classy all the way.
Incorrect and, frankly, highly dismissive of a real cause of suffering.
When we talk about the evidence for the reality of fibromyalgia, there’s two related concepts that need to be teased apart. The first concept is that fibromyalgia is only a psychological condition, also known as the “its all in your head” dismissal. This is false for the reasons I will go into below. The second concept is that fibromyalgia is a condition that is affected by or linked to psychological conditions like clinical depression. This second idea is much more accepted by the research community to varying degrees, but the jury is still out on whether depression causes fibromyalgia, whether the opposite is true, or whether the relationship between them is more complex. While many rheumatologists, internists, and family practitioners seem to be picking sides into competing “fibromyalgia causes depression” versus “depression causes fibromyalgia” camps, among specialist researchers the consensus seems to be that we don’t know the actual relationship between the two, save that it isn’t simple.
The only thing that is clear is that psychological factors are part of fibromyalgia and can exacerbate or alleviate the pain and other symptoms. A comprehensive treatment plan for fibromyalgia should include psychological as well as physical treatment approaches. The same could be said for most chronic pain diseases, however.
One other difficulty about discussing fibromyalgia is, as other posters have noted and as I said in the Staff Report, it is a diagnosis reached by ruling out other causes of chronic pain. This does not mean it is a “garbage pail diagnosis” as some (although not here) have claimed. The American College of Rheumatology has specific criteria that include not only trigger points, but pain at many widespread sites, fatigue, and pain levels that interfere with daily life. The weakness of a diagnoses of exclusion is that they may actually include multiple conditions within one syndrome. For an analogy, think back to the early days of AIDS. Not may people remember that in 1980 it was also once a diagnosis of exclusion of any generalized immune system disorder that started in later life (the reason it was initially named Acquired Immune Deficiency Syndrome). It wasn’t until the HIV/HTLV-III virus was discovered in 1983 that a causative factor was discovered and we knew that AIDS was one disease and not a series of conditions that shared similar symptom presentations. With fibromyalgia, we are still in that preliminary state where the etiology isn’t definitively known and there is a possibility that what is currently called one syndrome may cover multiple diseases.
I apologize at this point for seeming like I’m over-qualifying my earlier remarks, but I’d rather err on the side of being too narrow and specific than too broad and generalized.
All that said, there are multiple lines of research that substantiates fibromyalgia as a disease (or multiple diseases) with physical causes. Among these are that fibromyalgia patients have:
• Antibodies to serotonin (a neurotransmitter with many functions) and gangliosides (cell-surface markers in the brain important in immunological response) (Klein R, Bänsch M, Berg PA. 1992. Psychoneuroendocrinology. 17(6)593-598:11/1992)
• Altered processing of painful stimuli (Staud R, Vierck CJ, Cannon RL, et al. Pain. 91(1-2)165-175:3/2001 and Staud R, Cannon RL, Mauderli AP, et al. Pain. 102(1-2)87-95:3/2003)
• Reduced bloodflow in a part of the brain called the inferior pontine tegmentum (which is involved in initiating REM sleep) (Kwiatek R, Barnden L, Tedman R, et al. Arthritis & Rheumatism. 43(12)2823-2833:12/2000)
• Differences in ratios between neurotransmitters in the brain when painful stimuli are applied that are detectable by MRI (Feraco P, Bacci A, Pedrabissi F, et al. American Journal of Neuroradiology. 32(9)1585-1590:10/2011)
• Significantly altered heat pain tolerance, radically reduced cold pain tolerance, decreased threshold for the withdrawal reflex and other reproducible symptoms of central hyperexcitability of the nociceptive (pain processing) system (Desmeules JA, Cedraschi C, Rapiti E, et al. Arthritis & Rheumatism. 48(5)1420-1429:5/2003)
• Significant reduction in grey matter density in regions of the brain associated with processing of pain perception, cognitive dysfunction, and stress reactivity (Wood PB, Glabus MF, Simpson R, Patterson JC 2nd. Journal of Pain, 10(6)609-618:6/2009)
Together, these lines of research suggest that there is a structural or biochemical abnormality in fibromyalgia that causes central nervous system over-sensitization to pain and other noxious stimuli. The differences in the brain structure are especially clear in confirming that fibromyalgia is a real pathology.
On the contrary, there is no diagnostic test for schizophrenia, and no course of treatment shows the same consistent results that can be expected when treating pneumonia with antibiotics or lung cancer with radiation and chemotherapy. Medications used to treat schizophrenia primarily deal with symptoms of psychosis, which is only half the picture of the disease, there is argument over which class of anti-psychotic medication is more effective, and the rate of “good response” is, at best, 50%. We don’t understand the biochemical basis of schizophrenia. We have only a handful of theories which have not been completely substantiated - a genetic tendency, some environmental factors, drug use, prenatal factors - and the mechanism of the disease is almost completely unknown.
The only defining factor we can point to defining schizophrenia as a “proven” disease is the cross-section of symptoms differing from Alzheimers and the MRI scans showing changes in brain structure. Prior to the availability of that technology, you could have argued against schizophrenia being a “real” disease just as easily.
The same can be said for depression, post traumatic stress disorder, phantom limb pain, borderline personality disorder, anxiety attacks, premenstrual dysphoric disorder, and autism. They are diseases that rely on self-reporting and observation of symptoms and the elimination of other possible diseases and that anywhere from ten to one hundred years ago were dismissed as not being real. There are no hard, objective tests that cinch a diagnosis of any of the above diseases.
I cannot begin to express how frustrating it is to read or hear, over and over again, people who’ve never experienced these symptoms, or haven’t experienced them with the same intensity or the same duration, dismiss these illnesses as being “only in your head”. Yes, there are malingerers looking for an excuse with an official sounding string of words. There are also hypochondriacs, who know something is wrong and are desperate for a diagnosis so they can get some manner of treatment in the hope that this time, they’ll feel better. That does not invalidate those who genuinely experience the fatigue, pain, and weakness encompassed by fibromyalgia.
We are still in the process of unraveling the mysteries of the human body, especially the brain. There is still plenty of room to say “we don’t know”. Why, then, are so many people in a rush to deny what others have experienced? Does it make them feel safer? Superior? More in control of their own destiny?
You know what? Some times, people have shitty health. Some times, those health issues can’t be blamed on the person in question or any other direct, obvious cause. Some times, people live lives filled with pain, exhaustion, doubt, and despair. Some times, there’s no clear answer as to even what is going on that makes a person feel so cruddy. Just because there are no answers, easy or otherwise, does not mean the problem does not exist.
That’s not what I was trying to do or what I meant and is why I said “not really the case” (meaning “not completely the case”) as opposed to “not the case”, i.e. that those features are not as clear or as applicable to fibromyalgia. But I understand that an appeal to one’s sense of unfairness and to emotion, a bit of drama in other words, makes for a better sounding response.
All of which may or may not be relevant since it is problematic to do research on patients with a disease that has little or nothing in the way of objective diagnostic criteria, i.e. it can be problematic to determine that the patients actually have the disease you’re hoping to study. More importantly, and please correct me if I’m wrong, can any of those studies distinguish between phenomena that are due to fibromyalgia versus phenomena that may arise in any person who’s been experiencing chronic pain, stress, depression, sleep disturbance, etc., or possibly even due to the antecedent treatments the study subjects had undergone earlier. Are such comparisons even possible in the absence of a diagnostic gold standard?
ETA: To repeat what I said: “there is no diagnostic test which if positive proves the diagnosis of fibromyalgia. There is no agreed explanation on the pathogenesis of fibromyalgia. Treatment is essentially symptomatic and is no(n) specific. . . Taken together, the(se) features . . . don’t make a strong case for a “physical” disease (IMHO)”. Hardly “dismissive”.
Depression is real and physical just like any other disease (the brain being a physical organ subject to both disease states and treatment of same). In a society that still stigmatizes mental health as a moral failing, something you should “just get over,” or “not real,” of course a certain percentage of people with depression will be motivated to call it something else and attribute it to a neck-down cause.
Which just means you didn’t read, or didn’t care to try to understand, the research presented and the rest of the previous post.
I’ll make it simple: Fibromyalgia patients show structural abnormalities in the brain in the areas that are associated with processing of the symptoms of the syndrome.
You can’t show a more organic link than that.
It’s curious that, when the pancreas is involved in a disease of unclear etiology, everybody accepts that there is a “real” disease but when the brain is involved in a disease of unclear etiology, everybody wants to deny that it is every bit as “real.”
It’s even more curious that you accept the “reality” of schizophrenia when all of the objections you have to fibromyalgia apply equally, as phouka pointed out, to schizophrenia.
All of which leads to the conclusion that your mind is made up and I should stop trying to confuse you with facts. I hope the esteemed Bricker and others do not share such a prejudged position.
Well, if you insist on injecting ad hominem remarks, I’ll ask if you read (or understood) my questions. You quoted references and I asked legitimate questions about their methods. In fact, all the way through all my posts here I’ve made allusion to things like “correct me if I’m wrong”, used qualifiers such as “may” and “IMHO”, and tried to make it clear that although I’m skeptical I am most certainly not dismissive. Yet you insist on saying things like I’m dismissive and that you don’t want to “confuse me with facts”. For a member of the ostensible “Scientific Advisory Board” you seem to get pretty damn emotional when challenged (with legitimate questions).
Considering the clearly visible doubt faced by those with diagnoses of fibromyalgia, and the fact that there are different symptom clusters and diagnostic guidelines as well as brain imaging which shows differences in brain structure, I contest your claim.
I’ve spent a fair portion of the last 2 years undergoing a series of tests to figure out what was responsible not only for the exhaustion, aches and, scarily, the sudden onset of peripheral neuropathy. Multiple blood tests, MRIs, EMG, EEG, SSEP and lots of poking and prodding. I was put on a series of medications that have either on or off label uses as a treatment for Fibromyalgia or other nerve pains. They were either ineffective or the side-effects were worse than the symptoms. At the end of it all, they kind of said “eh, let’s call it Fibromyalgia”. My diagnosis is one of exclusion.
That said, I underwent a sleep study where my neurologist said that certain brain wave patterns during particular sleep stages were indicative of Fibromyalgia. I did not have those brain wave patterns 
KarlGauss, before you use Latin debating terms, it might be a good idea to know their meaning. For example, ad hominem literally means “to the man” and refers to an attack against the person himself or their qualifications. If you look at what I’ve said, you will note a distinct absence of ad hominem attacks. However annoying you found my posts, they were only about what you said, and therefore actually ad argumentum. Even the last line of my previous post says that your posts “…lead me to the conclusion that your mind is made up…” which, while perhaps distinctly personal, is also distinctly about what you have said. It is not about who you are or whether another person should trust your arguments or not based on your personal qualities.
In contrast, saying I “seem to get pretty damn emotional when challenged” is an ad hominem attack. It is about me and my emotional state and you go farther to insinuate that the SDSAB is somehow poorly served by my emotion. So at this point you may be considering the phrase tu quoque or “you, also”. In this case, it is somewhat appropriate because you have responded to what you thought I did in the same way. That is, you injected an ad hominem because you read one into my earlier post. In trying to call out one logical fallacy, you broke into another.
We could continue to trade accusations of intellectual failings back and forth until the cows come home. That won’t provide any further evidence that will lead to an answer for Bricker. So for my part in ratcheting up the animosity, I apologize.
To return to your previous post, the only “correct me if I’m wrong” I see is this:
Misconception #1: that there are “diagnostic gold standards” in medicine. If we were to demand that every disease be diagnosed in the way we diagnose, say, Clamydia trachomatis genital infections (i.e., through a blood test that reveals the presence of infectious organisms), we wouldn’t diagnose a large swath of diseases. Hypothyropidism, for example, can be sometimes be confirmed by testing of thyroid-stimulating hormone and free thyroxine levels in the blood, but not always. There is a portion of hypothyroid patients that have normal levels of these hormones but the bioactivity of them is reduced or inhibited, so they are diagnosed the same way that fibromyalgia is diagnosed: through the clinical picture of signs and symptoms. Asking for there to be a gold standard is a misconception that is fostered through medical dramas on TV, not reality.
Misconception #2: that a diagnosis of exclusion is inherently indicative of a lack of “reality” in the subject under discussion. In actuality, diseases that are widely and frequently accepted as “real” are diagnoses of exclusion. Alzheimer’s disease, for example, can only be confirmed after death through examinations of brain tissue. Every living person you know of or have heard of that is diagnosed with Alzheimer’s disease, from Ronald Reagan to Terry Pratchett to Pat Summitt, has been diagnosed through excluding other conditions that can cause similar symptoms. A diagnosis of exclusion does not mean: “We can’t find anything wrong with you, so we’ll call it X.” It means: “Given this presentation of signs and symptoms, the patient could have X, Y or Z. After running appropriate tests that have ruled out Y and Z, we are left with the conclusion that the patient has X.” This is called the process of differential diagnosis and it happens not only on every episode of House, but every day in every hospital in the Western world.
Misconception #3: that an unknown etiology or an unclear etiology means that a syndrome or disease is made up. In reality, the number of diseases that have an unknown cause is vast, ranging into the thousands of diagnoses. This ranges from more obscure diseases like Eosinophilic pneumonia, many cases of megaloblastic macrocytic anemia, Condylar hyperplasia, to more familiar diseases like migraines, most dementia, and multiple sclerosis. In all these diseases, the etiology is unclear or completely unknown. Any time you hear the descriptors of primary, idiopathic, or cryptogenic applied to a disease, you are hearing that the etiology is unknown.
That said, the question of distinguishing between fibromyalgia and Chronic Fatigue Syndrome (CFS) is an active one, but there is no question that fibromyalgia and depression are separate conditions. Clinical depression often accompanies fibromyalgia, as I earlier mentioned, but the overlap is not significant. That is, there are significant numbers of depression patients that do not meet the criteria for fibromyalgia and there are significant numbers of fibromyalgia patients that do not meet the criteria for clinical depression. Sa we can already readily distinguish between those conditions. Distinguishing between CFS and fibromyalgia is more problematic and some researchers consider them part of a continuum of CNS disorders. That does not, however, make either of them less “real”.
I hope by now I’ve demonstrated that all these features are neither unique to fibromyalgia nor should be considered a case for or against the physical nature of fibromyalgia. In contrast to this raft of misconceptions, I earlier posted studies that indicate a series of CNS processing deficits that are present in fibromyalgia.
Well, I kinda did, but it was based on absolutely no actual factual knowledge. Now I have some, and have revised my view accordingly.
As many Dopers have said before, it would be nice if there were a “Like” button on posts.
