# Is fibromyalgia a real condition? **URL:** \ **Category:** Factual Questions\ **Created:** [September 18, 2013, 8:08pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172 "2013-09-18T20:08:28Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![monstro](https://avatars.discourse-cdn.com/v4/letter/m/ba9def/32.png) [@monstro](https://boards.straightdope.com/u/monstro)\ **Post date:** [September 19, 2013, 6:21pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/41 "2013-09-19T18:21:32Z")
> [@Yarster](#): > > And perhaps these are all the reasons the OP would question whether it is real. Some people are really suffering from it, and have legitimate symptoms. Unfortunately, as with many diseases that don’t have an outward and obvious appearance to others, there will always be a very vocal and nutty sub-population of patients who use it as a synonym for “I’m crazy and also lazy”. I see this with depression as well. It seems that a good third of the people I meet these days are depressed. The way I distinguish the “real” ones from the “fake” ones is when an enjoyable activity comes up. When it is something unpleasant, like work, both the real and fake ones will either not show up at all, or show up late. When it is an enjoyable activity, only the real one will not show up or show up late. The fake ones are always on time and are unusually overly happy. Sure that could be a manic depressive, but the consistency sends up all kinds of red flags. It really struck a cord with me when **yellowjacketcoder** mentioned the girl he was dating because I see this quite a bit. > > My wife has a friend who misses an average of one workday a week due to depression, but has never once missed a party, Comic-Con, or other fun event and is often the first one to arrive to help set the event up. Maybe your wife’s friend is a piece of work, but this pattern doesn’t send up any red flags to me. An occasional bout of fun is a lot different from sustained work. It could be that she’d bail out early from a week-long party just as easily as she bails out of a week’s worth of working. One of the things that vexes the diagnosis of a multitude of illness is the waxing/waning of symptoms. For years I struggled with getting a diagnosis for my tic disorder because whenever I was in front of the doctor, I just happened to not have any tics. I could have “faked” them just to make it worth my while to be there, but then I would have been “faking” the disorder. It was only until my condition progressed to a certain (borderline embarassing) point that I was finally able to get a doctor to see that I had a problem. Before then, I had tons of people telling me it was all in my head. Making a mountain out of a molehill. Depression is also variable. When I was under the gray cloud, my symptoms would always get worse on the back end of the week versus the front. Sleep deficit combined with accumulation of stress plus the impending doom of the weekend. There are also monthly flunctuations to content with. Even terminal cancer patients have good and bad days. Judge at your own risk. ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [September 19, 2013, 7:10pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/42 "2013-09-19T19:10:40Z")
This reminds me of the discussion of ADHD in another thread. We need to distinguish between conditions and actual diseases - those conditions that we can test for and actually prove - AIDS/HIV positive, tuberculosis, appendicitis, nut allergies, smallpox, arthritis, death. You can perform specific tests and point to specific items - reaction to antibodies, inflamation of joints, fluid and inflamation in lungs, specific reaction when substances are inserted into a skin area, etc. Then there are conditions like ADHD, lupus, fibromyalgia, etc. - there are definitely people who have something wrong, but the only diagosis is a checklist against an established array of symptoms - joint pain, check; runs around and bounces off walls like a crazy little boy, check; claims to hear voices, check; etc. Check yes on an array of **subjective** questions in the right pattern, and here’s you diagnosis. It’s not to say the condition does not exist. It obviously seems to for some people. It may be mainly psychosomatic, or it may simply be a cause we haven’t found yet. (See the controversy over Zamboni and MS; if he’s right, it’s an incredibly simple cause that eluded some fo the best minds in research.) However, if there’s no specific test to prove a condition, anyone could claim to have it or to be (mis) diagnosed with it. It falls into the category of “best guess”. I suppose the other interesting point is that without a specific cause, there’s no guarantee a treatment works or if it instead falls into the category of “placebo”. ---
**Author:** ![Yorikke](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/yorikke/32/4335_2.png) [@Yorikke](https://boards.straightdope.com/u/Yorikke)\ **Post date:** [September 19, 2013, 7:21pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/43 "2013-09-19T19:21:14Z")
> [@picunurse](#): > > As you can see from my user name, I am a healthcare professional. And as you can see from my user name, I’m really an imaginary boat from “The Death Ship” by B. Traven. Thank god for 100% honesty on the internet. ---
**Author:** ![si\_blakely](https://avatars.discourse-cdn.com/v4/letter/s/d9b06d/32.png) [@si\_blakely](https://boards.straightdope.com/u/si_blakely)\ **Post date:** [September 19, 2013, 8:04pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/44 "2013-09-19T20:04:06Z")
> [@brazil84](#): > > I clicked on your first link; it appears that the word “lactic” does not appear in the article so I’m not sure I understand your point. The relevant quote > [@](#): > > At our clinic, fibromyalgia patients and controls were studied during rest and under different work loads. At rest and under submaximal loading there were no differences between the two groups, but under maximal load the patients produced only half as much work as the controls (A. Bengtsson et al., submitted for publication). The pH reduction was the same in controls and patients, as, for example, Vestergaard‐Poulsen et al. have also found [27]. **The patients thus reached the level of pH reduction at which pain and fatigue inhibit work after a much shorter time and under a lesser work load compared with the controls** pH reduction under exercise is due to lactic acid buildup - so I filled in the word. > [@brazil84](#): > > The second is paywalled. Odd - when I followed the link from Google the text popped right up. You can click the **Look Inside** link (upper left) to see the text for free. The [NHS](http://www.nhs.uk/Conditions/Fibromyalgia/Pages/Diagnosis.aspx) in the UK has specific diagnostic criteria, based on eliminating other possible causes (CFS, MS, RA), and including the following: > [@](#): > > Once all other conditions have been considered or ruled out, there are two criteria that can be used to confirm a diagnosis of fibromyalgia. If your symptoms fit within these criteria, it is likely you will be diagnosed with fibromyalgia. > > Criteria for diagnosing fibromyalgia are: > > ``` > widespread pain for more than three months on both the left and right sides of your body, above and below your waist > pain in at least 11 of the 18 'tender points' when they are pressed > > ``` > > Tender points > > These are the areas on your body where pain is likely to be at its worst. There are tender points at the back of your neck, above each of your shoulder blades and the inside of your elbows. Your GP may also press other areas that are not tender points, to compare how much more painful the tender points are. A GP will then probably refer you to a Rheumatologist at an NHS hospital. ---
**Author:** ![brazil84](https://avatars.discourse-cdn.com/v4/letter/b/8491ac/32.png) [@brazil84](https://boards.straightdope.com/u/brazil84)\ **Post date:** [September 19, 2013, 9:00pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/45 "2013-09-19T21:00:08Z")
> [@si\_blakely](#): > > The relevant quote pH reduction under exercise is due to lactic acid buildup - so I filled in the word. I see. So here is a thought experiment: Test people for fibromyalgia by putting them under specific work loads and measuring muscle pH reduction. If the pH reduction exceeds a specified threshold, conclude that the patient has fibromyalgia. Do you know why this hypothetical test is not used? I don’t know myself, but I have a feeling the problem is that you would actually be testing how sedentary the person is; that people who are more active generally have higher lactate thresholds than people who are less active; and that people with FM are generally less active than your typical person. ---
**Author:** ![tracer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tracer/32/20578_2.png) [@tracer](https://boards.straightdope.com/u/tracer)\ **Post date:** [September 19, 2013, 9:30pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/46 "2013-09-19T21:30:10Z")
> [@Yarster](#): > > They also never seem to be in a relationship and have usually done things to make themselves less desirable to a mate, such as being obsessed with Wicca, beanie babies, cats, etc. I have to admit, I’ve never heard anybody say “I was thinking of going out with her, but then I found out she likes beanie babies.” ---
**Author:** ![si\_blakely](https://avatars.discourse-cdn.com/v4/letter/s/d9b06d/32.png) [@si\_blakely](https://boards.straightdope.com/u/si_blakely)\ **Post date:** [September 19, 2013, 9:48pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/47 "2013-09-19T21:48:29Z")
> [@brazil84](#): > > I see. So here is a thought experiment: Test people for fibromyalgia by putting them under specific work loads and measuring muscle pH reduction. If the pH reduction exceeds a specified threshold, conclude that the patient has fibromyalgia. > > Do you know why this hypothetical test is not used? I don’t know myself, but I have a feeling the problem is that you would actually be testing how sedentary the person is; that people who are more active generally have higher lactate thresholds than people who are less active; and that people with FM are generally less active than your typical person. Observing that a group of fibromyalgia sufferers reach their fatigue threshold faster and under less load than a similar control group is interesting in that it provides avenues of investigation for root causes, but there is no way it can be considered diagnostic on an individual basis - there is no baseline, and the results only show up as a statistical result. But it does show that there is a statistically significant difference between FM sufferers and the control population (showing that there something causing the effect), and maybe it will lead to a further discovery that will be either diagnostic or point to treatments. ---
**Author:** ![Yarster](https://avatars.discourse-cdn.com/v4/letter/y/7c8e57/32.png) [@Yarster](https://boards.straightdope.com/u/Yarster)\ **Post date:** [September 19, 2013, 9:53pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/48 "2013-09-19T21:53:20Z")
**Tracer** - what I mean to say is that these people have very large collections of whatever the item of obsession is. That is, they have ten cats, rooms full of beanie babies, walls decorated in Wicca stuff in every room, etc. And yes, you may also know someone who is totally normal with a boxcar worth of beanie babies, but I would still suggest this is abnormal behavior. If people know what hobby you are into just by looking at you from down the street, I’d suggest there might be a problem. **monstro** - if observed under a short time period, I would agree that one couldn’t make the assumption that the symptoms aren’t waxing and waning. This girl in question has been friends with my wife for over a decade. I don’t claim my views apply to every patient, but this is the hueristic I use, because the real depressed people often won’t show for parties because they are self conscious or seeing other people having a good time bums them out. The simple fact you would say “the impending doom of the weekend” sounds like something a real depressed person would say. “The impending doom of the workweek” is what someone who is lazy or hates their job would say. ---
**Author:** ![Blue\_Blistering\_Barnacle](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/blue_blistering_barnacle/32/3386_2.png) [@Blue\_Blistering\_Barnacle](https://boards.straightdope.com/u/Blue_Blistering_Barnacle)\ **Post date:** [September 19, 2013, 10:50pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/49 "2013-09-19T22:50:53Z")
> [@Hari\_Seldon](#): > > My family doctor sure thinks so. My wife went to see him with some vague complaint. He said it might just be fibromyalgia. He didn’t think so, but there was a simple test. He prescribed something–I think it was prednisone. He said that if it really were fibromyalgia, the symptoms would disappear overnight. They didn’t, she stopped taking the drug and the symptom gradually dissipated. > > From this I drew the following conclusions. He thinks it is a real disease with a real treatment. My wife’s symptoms, while undiagnosed, were caused by some real disease, presumably some kind of infection that she fought off. And she isn’t nuts. I don’t diagnose or treat fibroyalgia or rheumatologic conditions, but I will say that prednisone will make a LOT of people feel better, even (or especially) if they don’t have fibromyalgia. It suppresses most inflammation and it has been a mainstay for treatment of many rheumatological conditions (many of which I suspect get labelled and treated as fibromyalgia). I have a very down to earth friend (who is no shirker) who was plagued by goofy symptoms (including chronic fatigue) which no one could figure out. Until she saw a rheumatologist who somehow figured out she had myositis (despite no muscle pain). She was treated with prednisone to great effect, back to her normal self, except now contending with side effects from prednisone. I have no doubt someone else might have labeled her fibromyalgia or chronic fatigue syndrome or whatever. She might have been treated the same way and had the same results. To this day I wonder how confident they were of their myositis diagnosis, or even if it makes a difference. Long story short, I personally think that fibromyalgia straddles the no man’s land between rhuematology and psychiatry, and whether or not it is “real” , it is now a large wastebasket catching up lots of people who have atypical presentations of other diseases and, yes, many malingerers. ---
**Author:** ![LouLou7](https://avatars.discourse-cdn.com/v4/letter/l/a87d85/32.png) [@LouLou7](https://boards.straightdope.com/u/LouLou7)\ **Post date:** [September 19, 2013, 10:51pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/50 "2013-09-19T22:51:11Z")
[quote=“Hari\_Seldon, post:15, topic:669172”] My family doctor sure thinks so. My wife went to see him with some vague complaint. He said it might just be fibromyalgia. He didn’t think so, but there was a simple test. He prescribed something–I think it was prednisone. He said that if it really were fibromyalgia, the symptoms would disappear overnight. They didn’t, she stopped taking the drug and the symptom gradually dissipated. If taking a dose of prednisone (or whatever the drug was) cured fibromyalgia overnight, I wonder why EVERY doctor wouldn’t just prescribe a dose of prednisone and watch the symptoms disappear??? :dubious: ---
**Author:** ![The\_Second\_Stone](https://avatars.discourse-cdn.com/v4/letter/t/bbe5ce/32.png) [@The\_Second\_Stone](https://boards.straightdope.com/u/The_Second_Stone)\ **Post date:** [September 19, 2013, 11:27pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/51 "2013-09-19T23:27:26Z")
My own doctor, who I think is a first rate genius, having worked as an engineer at Livermore National Labs, etc. thinks fibromyalgia is not a real disease. She is one skeptical lady. The reason I asked her is that I have a client with that diagnosis who was in a rear end accident while completely disabled from fibromyalgia (no, it didn’t cause the fibromyalgia). Her disability insurance company actually paid for two years of fibromyalgia disability after sending her to a specialist to verify she has the disease. I’m going to go with the insurance company, which could have just as easily excluded fibromyalgia as a disability. If they think it is real, then it is. They are monetarily interested and benefited if it is not. ---
**Author:** ![brazil84](https://avatars.discourse-cdn.com/v4/letter/b/8491ac/32.png) [@brazil84](https://boards.straightdope.com/u/brazil84)\ **Post date:** [September 20, 2013, 12:25am UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/52 "2013-09-20T00:25:35Z")
> [@The\_Second\_Stone](#): > > My own doctor, who I think is a first rate genius, having worked as an engineer at Livermore National Labs, etc. thinks fibromyalgia is not a real disease. She is one skeptical lady. The reason I asked her is that I have a client with that diagnosis who was in a rear end accident while completely disabled from fibromyalgia (no, it didn’t cause the fibromyalgia). Her disability insurance company actually paid for two years of fibromyalgia disability after sending her to a specialist to verify she has the disease. I’m going to go with the insurance company, which could have just as easily excluded fibromyalgia as a disability. If they think it is real, then it is. They are monetarily interested and benefited if it is not. Seems to me that the insurance company has to go by what the courts and the state insurance regulators decide. And the interests of the courts and regulators are not necessarily the same as those of the insurance company. ---
**Author:** ![TimeWinder](https://avatars.discourse-cdn.com/v4/letter/t/bcef8e/32.png) [@TimeWinder](https://boards.straightdope.com/u/TimeWinder)\ **Post date:** [September 20, 2013, 1:30am UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/53 "2013-09-20T01:30:04Z")
> [@The\_Second\_Stone](#): > > I’m going to go with the insurance company. Absolutely. A bunch of folks who are basically accountants are clearly much more qualified to diagnose diseases than someone who went to medical school. No contest. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [September 20, 2013, 2:29am UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/54 "2013-09-20T02:29:28Z")
It _may_ be better to think of fibromyalgia less as “a disease” than as “a symptom complex.” It is a chronic pain syndrome and the thing about chronic pain syndromes is that they are often self-pertpetuating. They also travel with a variety of mental health issues in both directions. The brain is integral in pain perception and the neurotransmitters involved in mental health also impact pain perception. Screw up those receptors in one way and no shock they can act screwy in other ways too. Once someone is in chronic pain it is hard to treat. ---
**Author:** ![Chief\_Pedant](https://avatars.discourse-cdn.com/v4/letter/c/a6a055/32.png) [@Chief\_Pedant](https://boards.straightdope.com/u/Chief_Pedant)\ **Post date:** [September 20, 2013, 2:37am UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/55 "2013-09-20T02:37:36Z")
> [@md2000](#): > > Then there are conditions like ADHD, lupus, fibromyalgia, etc. - there are definitely people who have something wrong, but the only diagosis is a checklist against an established array of symptoms - joint pain, check; runs around and bounces off walls like a crazy little boy, check; claims to hear voices, check; etc. Check yes on an array of **subjective** questions in the right pattern, and here’s you diagnosis. Lupus? [LUPUS (?!)](http://www.cedars-sinai.edu/Patients/Health-Conditions/Images/351457_Lupus-1.jpg) Hello? I believe you have your “diseases of the nutty” mixed up with “diseases associated with laboratory abnormalities and physical findings.” ---
**Author:** ![HoneyBadgerDC](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/honeybadgerdc/32/1033_2.png) [@HoneyBadgerDC](https://boards.straightdope.com/u/HoneyBadgerDC)\ **Post date:** [September 20, 2013, 2:50am UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/56 "2013-09-20T02:50:17Z")
> [@Chief\_Pedant](#): > > Lupus? [LUPUS (?!)](http://www.cedars-sinai.edu/Patients/Health-Conditions/Images/351457_Lupus-1.jpg) > > Hello? > > I believe you have your “diseases of the nutty” mixed up with “diseases associated with laboratory abnormalities and physical findings.” Lupus is a real disease no doubt, but it is also one of those catch all diseases that folks with idiopathic symptoms tend to get labeled with. My exwife was diagnosed with lupus, her biggest complaint was chronic leg pain, cramps and seizures. The seizures were caused by drug withdrawal as she would take massive amounts of opiats, soma and one other thing I can’t rememeber and then suddenly stop when she went back to work as a critical care nurse. The siezures were alwasy toward the end of her shift on her third day back at work. I have no doubt the leg cramps were from dehydraton. She eventualy died of a drug overdose, ---
**Author:** ![Uber\_the\_Goober](https://avatars.discourse-cdn.com/v4/letter/u/58956e/32.png) [@Uber\_the\_Goober](https://boards.straightdope.com/u/Uber_the_Goober)\ **Post date:** [September 20, 2013, 12:38pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/57 "2013-09-20T12:38:19Z")
> [@TimeWinder](#): > > Absolutely. A bunch of folks who are basically accountants are clearly much more qualified to diagnose diseases than someone who went to medical school. No contest. The point is, insurance companies don’t pay for treatment of “Multi-colored swamp ass fever” because it’s not a real disease. They pay for (quite a LOT actually) treatment for fibromyalgia; this indicates it is accepted by them as legitimate - even though they are financially invested in finding reasons to NOT treat bogus diseases. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [September 20, 2013, 1:02pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/58 "2013-09-20T13:02:29Z")
Insurance companies pay for lots of stupid stuff. Look no farther than that chiropractic adjustments for things that chiropractic adjustments are clearly shown to not work for which are covered by many insurance plans. Using what label an insurance company will accept as your gold standard is using a very silly metric. Which is not me arguing that fibromyalgia isn’t “real.” It is real - as a grab bag for chronic somewhat diffuse muscular pain syndromes of unclear etiology. It needs treatment and treatment should be covered. Depending on the indidual such treatment may be more focused on the mental health aspects of the condition or on physical therapy or increased exercise or on pain management or on reducing dependency on some sorts of pain medicines. Usually more than one focus is required. Lupus OTOH is no grab bag catch all and has very specific lab tests in addition to clinical findings to support its diagnoisis. An n of 1 ex wife being labelled with lupus who had a variety of other issues going on either means that she was being treated by an idiot who did not know what lupus is, or that she had lupus and she had many other problems, like drug addiction, which seem to have been her more serious and undertreated disease. ---
**Author:** ![brazil84](https://avatars.discourse-cdn.com/v4/letter/b/8491ac/32.png) [@brazil84](https://boards.straightdope.com/u/brazil84)\ **Post date:** [September 20, 2013, 2:00pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/59 "2013-09-20T14:00:59Z")
> [@Uber\_the\_Goober](#): > > The point is, insurance companies don’t pay for treatment of “Multi-colored swamp ass fever” because it’s not a real disease. No, they don’t pay for treatment of “Multi-colored swamp ass fever” because the courts and regulators don’t make them. If they declined to pay for treatment, and insureds started filing lawsuits and regulatory complaints, and the courts and regulators decided in favor of the insureds, then they would start paying. ---
**Author:** ![MrPeabody](https://avatars.discourse-cdn.com/v4/letter/m/7cd45c/32.png) [@MrPeabody](https://boards.straightdope.com/u/MrPeabody)\ **Post date:** [September 20, 2013, 3:12pm UTC](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172/60 "2013-09-20T15:12:24Z")
Insurance companies pay based on the law of large numbers. Sometime these numbers are affected by risk of lawsuit. For example, In a car acc it is sometimes cheaper to pay $2,000 for a fake back claim than to pay $25,000 to challenge it in court and still have the risk of loss at trial. So if you follow the money you will find there is a reason for seemingly ridiculous practices. [Previous page](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172.md?page=2) [Next page](https://boards.straightdope.com/t/is-fibromyalgia-a-real-condition/669172.md?page=4)