Fibromyalgia Wars

Fibromyalgia (FM) is easy to recognize. Patients diagnosed with it have medically unexplained symptoms (MUS)¹ that are often severe and generally include widespread pain, fatigue, sleep disturbance, depressive symptoms, cognitive problems, irritable bowel syndrome, multiple somatic symptoms, and a single partially objective sign — tenderness on palpation². Representing perhaps 2% to 4% of the adult population³, patients with FM incur substantial direct and indirect medical costs, including high rates of disablement.

FM is a bitterly controversial condition. It pits patients, pharmaceutical companies, some specialty physicians, professional organizations, and governmental agencies — groups with substantial political and economic power who benefit from the acceptance of FM — against the large majority of physicians, sociologists, and medical historians in what we call the “fibromyalgia wars.”

The wars are fought over a series of questions that concern the legitimacy of the diagnosis. In the balance is access to care and disability awards for patients; careers, publications, funding, and salaries for academic physicians; profits for pharmaceutical companies; political power that influences government, research agencies, and professional organizations; and rewards for the legal system. The consequences of the dispute are societal and are best understood in terms of medicalization⁴ and social construction^5,6.