I personally do not believe fibromyalgia exists as a discrete disease entity. Rather, fibromyalgia is a constellation of various physical and psychological symptoms. It is not much of a stretch to say that everything from attention deficit disorder to global warming has been attributed to fibromyalgia, yet as far as I know, there is not a single shred of scientific evidence (blood test, biopsy specimen, X-ray, photograph) to support the existence of such a disease.

This does not mean I discount the symptoms patients report. I simply think it is intellectually dishonest to attribute the symptoms to a disease we cannot prove or even accurately describe. In the end, I strongly suspect the syndrome we call “fibromyalgia” will prove to be several different disorders. Some are probably physical – perhaps various manifestations of arthritis or metabolic syndromes. Other cases may be unusual presentations of stress or depression. Certainly, multiple ailments can exist simultaneously.

The primary question then becomes “what do we do about it?” My belief is that, after correctable pathology has been excluded to the extent possible, we are left with trying to address the symptoms. Various medications have been tried including steroids, antidepressants, analgesics, vitamins, herbs, and nutritional supplements. Other interventions have included physical therapy, support groups, and counseling. While some degree of success has been experienced sporadically, there have been no consistent results using any of these approaches. This leads me to have a deep suspicion that there must be multiple etiologies for the symptoms attributed to fibromyalgia. Cymbalta (an antidepressant) and Lyrica (a medication affecting nerve conduction) have offered substantial relief to many patients, but the results are not universal. Narcotics are not appropriate for this condition.

I strongly advise all patients labeled with this nonspecific and troubling diagnosis to make every effort to remain fully active, both physically and socially. I also recommend keeping an open mind about the validity of the diagnosis. It is probable that we will have better explanations of this syndrome in the future. In the meantime, it is imperative that patients avoid using this diagnosis as a “crutch” to explain away every adverse symptom or experience they have. Doing so may mask other underlying illnesses, and it certainly will diminish quality of life.

My opinion

Thomas L. Horton, MD