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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 construction5,6.
PATIENTS WITH FM AND THE BATTLE FOR SYMPTOM LEGITIMACY
A central concern of patients with FM and similar MUS illnesses is disbelief: that their physicians and the medical profession don’t believe them7,8; that physicians see their symptoms as ordinary — something that everyone has at one time or another, not serious, psychosomatic — in your head, a mental problem or the result of depression6–12. Sensing disbelief, the commentaries of FM patients and their interactions with the medical system are filled with a sense of delegitimization, betrayal, and anger7.
There is a lot …