Fibromyalgia Exposed from a Point-Counterpoint Perspective: Positive and Negative Implications of Medical Intervention

Dear Colleagues,

Fibromyalgia is a term utilized by rheumatologists to describe certain common musculoskeletal phenomena that cannot be easily ascribed as enthesial in derivation. In the analogy of the blind people and the elephant, we as rheumatologists call it fibromyalgia, while physiatrists refer to similar phenomena as myofascial pain syndrome. The phenomena, which the two terms identify, do not precisely mirror each other, but rather form more or less overlapping circles. Fibromyalgia has long been a controversial diagnosis, not only with significant supporters and deniers of its very existence, but also problematically used as a “waste basket” diagnosis, when the physician could not identify the source of a patient’s complaints. The latter often relates to insufficient education/exposure to musculoskeletal problems during the training of primary care physicians and to the highly focused training/experiences of those of orthopediatricians.

Initially diagnosed by rheumatologists on the basis of reproducible patterns of trigger/tender points (with the assurance that tenderness was wholly limited to those sites), the diagnosis fibromyalgia seems suggested for general or regional body pain. The latter compromises distinguishing it from allodynia, where touch sensations are perceived as pain. Part of the challenge has been non-musculoskeletal symptoms routinely associated with fibromyalgia (e.g., sleep disturbance, fatigue, headaches, abdominal pain). Additionally, the analogy of dogs having both ticks and fleas appears relevant. Fibromyalgia may occur in isolation, but its symptoms are observed in other disorders, including major rheumatologic diseases (e.g., rheumatoid arthritis, lupus), with ensuing distraction and difficulties determining what problems are related to that underlying disease and what to secondary fibromyalgia.

The Special Issue is a point–counterpoint conversation related to fibromyalgia and allodynia, providing the opportunity to publish a significant number of articles on existence, diagnosis, pathophysiology, intervention and patient education. This Special Issue encourages submissions addressing all aspects.

Prof. Dr. Bruce M. Rothschild
Guest Editor

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• fibromyalgia
• allodynia
• myofascial pain syndrome
• musculoskeletal disease
• fatigue
• sleep disturbance
• patient education
• physician burnout