The finding that all ill people can “symptom intensify” and persons with Fibromyalgia(FM) don’t do it any more than any other illness is another nail in the coffin for FM being psychological. There will be a subgroup in FM that is very disabled. These people could have undiagnosed physical problems or could be poor copers – the latter not occurring in any excess to that found in any other medical illness.
J Rheumatol. 2006 Sep 1; [Epub ahead of print]
The Symptom Intensity Scale, Fibromyalgia, and the Meaning of Fibromyalgia-like Symptoms.
Wolfe F, Rasker JJ.
They evaluated 25,417 subjects with Rheumatic diseases ranging from Rheumatoid arthritis to Fibromyalgia.
They concluded:
We identified a clinical marker for general symptom intensification that applies in all patients and is independent of a diagnosis of FM. We found no clinical basis by which FM may be identified as a separate entity. Higher scores on the Symptom Intensification scale were associated with more severe medical illness, greater mortality, and sociodemographic disadvantage, and these factors appear to play a role in the development of FM-like symptoms and symptom intensification.
Comment – Persons with Fibromyalgia have a problem with pain processing:
Eur J Nucl Med Mol Imaging. 2006 Aug 25; [Epub ahead of print] (99m)
Tc-ECD brain perfusion SPECT in hyperalgesic fibromyalgia.
Guedj E, Taieb
CONCLUSION: In the present study, performed without noxious stimuli in hyperalgesic FM patients, we found significant hyperperfusion in regions of the brain known to be involved in the sensory dimension of pain processing and significant hypoperfusion in areas assumed to be associated with the affective-attentional dimension. As current pharmacological and non-pharmacological therapies act differently on the two components of pain, we hypothesise that SPECT could be a valuable and readily available tool to guide individual therapeutic strategy and provide objective follow-up of pain processing recovery under treatment.
In acute pain, subjects are moaning, guarding themselves, sweating, tremoring, and in distress. In chronic pain you see nothing except they are not moving because moving hurts. FM subjects are never going to get any respect because the problem lies with central processing of pain. Sure there are some poor copers but that is not FM.
The situation of FM being considered primarily psychological reminds me a bit about ADHD. They are assumed to be mischievous and delinquent. It is true that a few ADHD subjects may also have a conduct disorder but ADHD is NOT a conduct disorder.
So a few FM subjects are poor copers and end up severely disabled perhaps from symptom magnification – but you can find that in any disease. Poor coping is NOT FM.