Talk:Fibromyalgia

Blanket psychobabble about distress may not apply to a proportion of patients

This may be useful when published, there are probably similar conclusions in other studies but I came across this when looking for something else and thought that others who edit this FM article may find it interesting, I don't pay much attention to the FM article or talkpage so I probably won't remember later: http://www.ncbi.nlm.nih.gov/pubmed/22065070 - Tekaphor (TALK) 02:20, 21 November 2011 (UTC)

"Psychobabble" is right. Any time someone uses the term "co-morbid" it's time to suspect pure psychogenesis is involved. According to Freud, though, fibromyalgia (Freud called it "neuraesthenia" or nervous exhaustion) is a general form of hysteria, and as such always starts out as a physical condition which the unconscious finds use for in the form of a mental illness. For instance; hysterical blindness is always triggered by something like a blinding explosion or a lightning strike. So the vast list of co-morbid psychological symptoms actually are co-morbid to a physiological illness--technically speaking that is. Snud (talk) 06

15, 15 January 2012 (UTC)

Tai chi

I restored the summary of the RCT of tai chi. This was previously removed because "One small study. Virtually meaningless". While not the best RCT in the world, it is the best RCT of tai chi for fibromylagia. I added that the RCT was small and single blinded. Please not that the edit does not recommend tai chi, it honestly notes that tai chi may help. To remove this edit, at least while there are not better trails, does not make sense. Wikipedia is full of content in medical articles that have one or no studies cited. Do we call all of that content virtually meaningless and delete? The deletion of tai chi seems capricious. If the goal of wikipedia is to provide the best knowledge available, then this edit must remain until better research emerges. - Robert Badgett 22:29, 10 December 2011 (UTC)

Robert, first, you can automatically sign using ~~~~. Makes it easy for you. Here's my issue with your edit, and I'm reviewing the article. It kind of fails WP:MEDRS because it seems like a primary study. I don't think it's been repeated in larger studies. The problem with these small prospective type of studies is that they are often overturned with future research. They're written in a "predictive" type of language. You even write it that way. Also, is it tai chi? Or is it just getting out and doing any type of stretching exercise. Would pilates do the same thing? Or 100 sit-ups? That's why these studies drive me up the wall. OrangeMarlin ^{Talk• Contributions} 23:09, 10 December 2011 (UTC)

I agree that the predictive wording is inappropriate for Wikipedia and I think it should be removed. As far as secondary sources are concerned, PubMed reports that this article refers to the tai chi RCT in question. The new article appears to be a review, but I can't tell much from the abstract. I think it would be worthwhile for someone with access to this journal to look up the article. -- JTSchreiber (talk) 05:09, 16 December 2011 (UTC)

Natural Suggestions for Pain Relief

I would like to consider adding a portion on Natural Pain relief because there is a lot of talk right now about how patients are finding relief (not a cure) by exercise and diet. There is also a lot of talk about the idea of massage helping and I do believe this information would benefit others who are suffering from Fibromyalgia.

The site NaturalFibromyalgiaTreatments.com has a lot of really useful information and resources about not only exercise and healthy eating but also about how certain vitamins (such as Vitamin D) and superfoods can help reduce risk of further health problems.

This website has been a HUGE help to me and I'd love to be able to share it with others who are also looking for relief without pills and surgeries: http://naturalfibromyalgiatreatments.com/ — Preceding unsigned comment added by Foderak (talk • contribs) 18:37, 10 January 2012 (UTC)

Any information needs to comply with WP:MEDRS, so adding that website would not be acceptable. However it is certainly plausible that massage, exercise and diet (and similar) could help fibromyalgia. I would suggest finding a good review that discusses this - the easiest way to find something would be to look on either google scholar or pubmed. --sciencewatcher (talk) 19:29, 10 January 2012 (UTC)

Hello, I'd also like to continue the discussion of adding a section regarding natural treatment of pain relief. Significant advancements have been shown regarding CAM (Complementary and Alternative Therapies), and think it would be a productive and helpful addition to the page. Perhaps something like below:

Numerous CAM options are available for treating Fibromyalgia(1-3). An integrated approach, using what has been called the SHINE protocol, treats with Sleep and Hormonal support, Infections, Nutritional support and Exercise and was shown to help 91% of patients, improving overall quality of life by an average 90%.(2) Two studies have also shown Ribose 5 gm 3 x day to be helpful (4,5), increasing energy an average of 61% in 1 multicenter study(5).

1. J. Teitelbaum and B. Bird, “Effective Treatment of Severe Chronic Fatigue: A Report of a Series of 64 Patients,” Journal of Musculoskeletal Pain 3 (4) (1995): 91–110. http://informahealthcare.com/doi/abs/10.1300/J094v03n04_11

2. J.E. Teitelbaum, B. Bird, R.M. Greenfield, et al., “Effective Treatment of CFS and FMS: A Randomized, Double-Blind Placebo Controlled Study,” Journal of Chronic Fatigue Syndrome Vol. 8, No. 2, 2001. PP3-28 http://www.jacobteitelbaum.com/documents/The-Definitive-Study-CFS-Research-by-Jacob-Teitelbaum.pdf

3. Rakel, D ed., Integrative Medicine, third edition. Chapter 47. Chronic Fatigue Spectrum p447-455. 2012. Elsevier/Saunders. http://www.expertconsultbook.com/expertconsult/ob/book.do?method=display&decorator=none&type=bookPage&eid=4-u1.0-B978-1-4377-1793-8..00100-X&isbn=978-1-4377-1793-8&hitTerms=%221546+993x%22%7C%22integrative+medicine%22%7C1546%7C1546-993x%7C993x%7Cteitelbaum&hitNum=2&simulateUpsell=true

4. Teitelbaum JE, JA St.Cyr, C Johnson. The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. J Alternative and Complementary Medicine 2006;12(9):857-862. http://online.liebertpub.com/doi/abs/10.1089/acm.2006.12.857

5. Jandrain J, McGrew R., Teitelbaum JE, Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia with D-ribose—A Multicenter Study. Scripps Conference 2010 San Diego, California (full study has been accepted for publication. In Press. Open Pain Journal (A link to the study on the website should be available within the next month))

Thanks for your input! Aloha76 (talk) 20:31, 5 June 2012 (UTC)

Generally speaking Wikipedia articles on medical topics should use review articles published in reputable journals, not primary research papers. WP:MEDRS explains what we strive for. The only one in your list that meets that criterion is #3. Looie496 (talk) 21:14, 5 June 2012 (UTC)

Possible bias against opiates

• • PROMINENT BIAS against opiate based medications in the treatment, opiates, section needs to be addressed. Recent NICE (UK) guidelines for pain management target this bias, which is largely baseless, and recommend more appropriate opiate prescription. This section is being used anecdotally by GP's (really!) to refuse proper pain medication. The bias against low dose opiate treatment for chronic pain needs to be removed and a better researched section put in its' place. I would suggest review of current prescribing guidelines as opposed to speculation based on outdated and opinionated meta-studies (the quality of studies included in same is dreadful and also very outdated) As Wikipedia becomes more widely trusted it is important that bias such as this is NOT included, especially in medical articles ** — Preceding unsigned comment added by Klmccaughey (talk • contribs) 18:35, 16 July 2012 (UTC)

Per Wikipedia's guideline on medical sources, statements about effectiveness should be based on peer-reviewed medical studies, especially high quality reviews of medical studies. What peer-reviewed medical studies do you have to support your view that the current content is outdated? If the UK guidelines include a review of peer-reviewed medical studies, that may be usable as a reference for effectiveness. Otherwise, the only way to use the UK guideleines as a reference would be in support of new content describing the UK guidelines. Such a description of UK guidelines should be brief and should not replace any current article content. -- JTSchreiber (talk) 05:06, 22 July 2012 (UTC)

The source for the second half of the Opioids section says there are "no randomized controlled trials addressing the short- or long-term use of opioids in FMS" If that is true, does this source fail Wikipedia's guideline on medical sources ? I can only access the abstract and don't know what the basis is for the conclusions it asserts. Spdem2 (talk) 00:47, 23 July 2012 (UTC)

I don't understand why the statement that you quoted may be problematic per Wikipedia's guideline on medical sources (WP:MEDRS). Please provide a quote from WP:MEDRS to show what you think the issue is. Also, I noticed that you changed "no evidence" to "insufficient evidence" in the article. I think that may be misleading, in that some readers may interpret this to mean that the review found some evidence, but not enough. -- JTSchreiber (talk) 05:36, 25 July 2012 (UTC)

From WP:MEDRS "The best evidence comes primarily from meta-analyses of randomized controlled trials (RCTs)" This source says there aren't any, so how can it meet the guidelines? What is the basis for the opinions stated? Am I missing something? My changes to "insufficient evidence" are directly from the abstract provided by the source. I think "no evidence" is misleading. Spdem2 (talk) 08:28, 27 July 2012 (UTC)

The source does not fail MEDRS; describing the literature (i.e. the lack of studies) does not "fail MEDRS". That there lacks high quality studies doesn't mean we don't talk about them, it just means we have to describe the state of the literature as best we can with best available sources (in this case literature review on the topic). By your logic, any condition that doesn't have systematic reviews of RCTs would not be able to be discussed on Wikipedia, which is clearly not correct. Yobol (talk) 13:53, 27 July 2012 (UTC)

OK, I missed the term "insufficient evidence" in the abstract. That wording is fine, but I think that "no randomized controlled trials" would be better, since it's more precise. I agree with Yobol about how to interpret WP:MEDRS. If we use an interpretation similar to yours for, say, Tramadol, then we would remove all current Tramadol content, because none of it is based on meta-analyses of RCTs. -- JTSchreiber (talk) 05:31, 30 July 2012 (UTC)

Perhaps I'm not being clear. I don't have an issue with it saying there is a lack of studies. It is this statement I have an issue with: " ...are not recommended as they can worsen mood, such as depression in fibromyalgia, have abuse and dependence potential as well as have a significant adverse effect profile. Long-term use of opioids may worsen pain in some people... " This is a strong POV, but are there any RCTs that found that opioids will worsen mood, depression and pain? Was it a meta analysis of RCTs? I believe at least one of the statements on Tramadol was a meta analysis of RCTs. I am no expert, but there seems to be an inconsistent standard applied based on who is doing the changes to this article. Spdem2 (talk) 05:56, 16 September 2012 (UTC)

Thanks for the clarification. I don't have access to the body of the article, so I do not know what type of evidence was used. I am going to wait a little while longer to see if anyone else comments. If not, I will try to get some help with this.

As far as meta-analyses, that type of research is a statistical approach in which data from multiple similar studies are contrasted and/or combined. I see no meta-analyses of RCTs in the Tramadol section. Note that WP:MEDRS doesn't say that meta-analyses are required. We often use other types of reviews instead. They can be high quality, depending on the type of evidence that is being reviewed. -- JTSchreiber (talk) 05:23, 24 September 2012 (UTC)

Thanks for checking it out. As far as Tramadol, I'm happy to hear you think the evidence meets WP:MEDRS. It took a lot of effort to get this information into this page. Spdem2 (talk) 10:09, 24 September 2012 (UTC)

Since no one has responded on the talk page, I have requested assistance from WikiProject Medicine in this section . -- JTSchreiber (talk) 05:51, 9 October 2012 (UTC)

(outdent) Klmccaughey, do the NICE guidelines on pain specifically mention fibromyalgia? I suspect that the NICE guidelines are not talking about a centralised pain syndrome such as fibromyaligia. Pain that originates from the nervous system, peripheral or especially central nervous system does not typically respond to opiates. There is no doubt that some patients have opiates withheld unfairly when they need them for pain that is opiate responsive, eg bone/joint/soft tissue pain.--MrADHD | T@1k? 16:16, 22 July 2012 (UTC)

(outdent) The NICE guidelines are with reference to treating pain in primary care, particularly chronic pain. JTSchreiber: Just because the author of this bias hasn't seen a study does not mean there are none. I would suggest there are multitudes of studies about the efficacy of opiates and chronic pain. As Fibromyalgia is a syndrome and not a disease or specific disease process these guidelines, along with the very latest on chronic pain, are not only relevant but key to the discussion. If we are saying that Fibromyalgia should not be treated with opiates then the specifics of the evidence for this need to be cited and shown in context. Just because the person writing this bit of bias has seen no evidence that opiates are effective does not mean there is none. Either say something is so and reference it, or say nothing at all. I feel the phrase asserting that opiates are ineffective should be dropped as it does not have significant basis in fact. — Preceding unsigned comment added by Klmccaughey (talk • contribs) 20:10, 10 August 2012 (UTC)

Discussion of the use of opioids is already extensively and well referenced to WP:MEDRS compliant sources. I'm not sure what your suggestion is, though it appears you seem to have a personal objection to the conclusion of the sources, which does not factor into how we write articles here. We care what sources say, not what individual editors believe. Yobol (talk) 20:16, 10 August 2012 (UTC)

Klmccaughey, you are entitled to your opinions about what is relevant and key. However, from a Wikipedia policy perspective, it doesn't matter what the NICE guidelines say about chronic pain. It also doesn't matter if there are "multitudes" of studies about opiates and chronic pain. Per Wikipedia's policy on original research, the guidelines and studies need to be explicitly about fibromyalgia or they cannot be used as sources in the fibromyalgia article. What evidence from WP:MEDRS compliant sources do you have about the effectiveness of opiates for fibromyalgia? If you cannot provide such sources, you have very little chance of getting people here to agree with your suggested changes to the article. -- JTSchreiber (talk) 04:46, 13 August 2012 (UTC)

Can someone please point me to the NICE guidelines? If they're a recent update, I'd like to look at them for another article. --Anthonyhcole (talk) 15:49, 11 August 2012 (UTC)

Regarding opiates, coming over from WT:MED

Having looked at the full text of PMID 21303476, the tone of the language described at WT:MED seems consistent with the article. For example, here is the entire Discussion section of that article (extending from page 9 to page 10 of the original):

DISCUSSION
Despite a lack of evidence supporting the efficacy of opioids in FMS, their use remains prevalent. A small non-controlled study suggests that they are of no benefit and may actually exacerbate co-existent disturbances of mood. Impaired μ-opioid receptor binding has been demonstrated in the areas important in pain and nociception processing in the brains of patients with FMS, suggesting further that these agents are unlikely to be useful. Improvements in our understanding of the neurobiology of FMS have helped the development of pharmacotherapy targeted to the pathophysiology of the condition. Opioids can be particularly problematic in patients with FMS. Without concrete evidence of their benefit, and the availability of other medications which act on pathophysiological mechanisms, it is difficult to see a current role for opioids in a long-term FMS management program.

I hope this is helpful. -- Scray (talk) 06:08, 9 October 2012 (UTC)

Also from page 9, a section on Tramadol:

Tramadol
While data for benefit of opioids in FMS is lacking, there are several randomized controlled trials that support the use of tramadol in FMS. Tramadol is a novel analgesic agent with combined μ-receptor agonist and 5-HT and NE reuptake inhibition activity. This additional action of preventing neurotransmitter reuptake is possibly the key to the superior efficacy of tramadol compared to other opioids in FMS symptom control. A double-blind, controlled trial of 12 patients with FMS demonstrated an improvement in pain, as measured by a visual analogue scale (VAS 100 mm), but no clinically important difference in terms of tenderness outcomes.41(Biasi, PMID 9604730) A subsequent double-blind, randomized controlled trial of 315 patients found that patients taking a 37.5 mg tramadol/325 mg acetaminophen combination tablet had improved pain scores and less discontinuation of medication than the patients in the placebo group (48% vs. 62%,P=0.004).42(Bennett, PMID 12753877) These patients also had better Fibromyalgia Impact Questionnaire scores, with significant improvement in physical functioning, role-physical, body pain, health transition and physical component summaries. A follow-up study examining the healthrelated quality of life (HRQOL) in these patients found that those with more severe pain had a greater impairment of HRQOL and that tramadol/acetaminophen-treated patients had a greater improvement in HRQOL compared with those who received placebo.43(Bennett, PMID 16082646) Tramadol is therefore included in the EULAR guidelines for the management of FMS with a level of evidence of Ib (evidence from at least one randomized controlled trial).

Hope this helps as well. -- Scray (talk) 06:31, 9 October 2012 (UTC)

Thanks! That does help. -- JTSchreiber (talk) 05:43, 12 October 2012 (UTC)

Fibromyalgia webcomic maybe useful

Fibromyalgia for Beginners