Talk:Fibromyalgia/Archive 5

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New proof of PHYSICAL NATURE

Study done by University of Illinois indicates that Fibromyalgia is detectable in blood, and is Immune related. Other studies have had similar results, adding to the evidence that this is a Physical, not Psychological illness. A blood test has been developed based on the results of the study: see http://www.biomedcentral.com/1472-6890/12/25 and http://thefmtest.com/. Fms girl (talk) 18:43, 18 May 2013 (UTC)

Note: I've changed the format of your refs to make them easier to access. Looie496 (talk) 19:44, 18 May 2013 (UTC)

• That's interesting but it's a primary source, and is not compelling (third-tier specialty journal, the conclusions are vague on the diagnostic utility of the test). We need to see how this gets incorporated into the scientific consensus (we follow, not lead, mainstream scientific opinion). The standards to which we adhere usually require a secondary source (e.g. an independent review article in a high-quality journal/textbook). Definitely intriguing, though. -- Scray (talk) 00:56, 19 May 2013 (UTC)

A new study this month has found a link between a specific type of nerve receptor that can be found in the palm of patients' hands and FMS; more support for a physical cause. The article is in the June Issue of pain med; it's under the MusculoSkeletal section. Here's a link to the journal index: http://www.painmed.org/Workarea/DownloadAsset.aspx?id=8919

On top of that, there's been a Netherlands study that was recently done, raising more support towards the idea that weather does not affect pain levels in Fibromyalgia. I can't find the journal article but here's a link to redorbit that mentions it: http://www.redorbit.com/news/health/1112864551/weather-conditions-do-not-affect-fibromyalgia-pain-or-fatigue/

Also, while on the topic of redorbit, here's their news article about the first study I mentioned: http://www.redorbit.com/news/health/1112877149/fibromyalgia-tissue-pain-hands-feet-fatigue-061813/

And I do want to mention that I hope I provided these resources correctly - I love Wikipedia and its comprehensiveness, I'd just like to help contribute new knowledge to the compendium; sorry I don't have a user account, c'est la vie for now. 24.49.184.132 (talk) 02:40, 24 June 2013 (UTC) -- A stranger that cares

As Scray said, we shouldn't make use of primary research publications like those. There are claims of new discoveries popping up just about every month, and few of them stand the test of time. If we want to have a reasonably stable article, we need to restrict ourselves to information that has been validated by multiple sources (see WP:MEDRS). Looie496 (talk) 16:17, 24 June 2013 (UTC)

Controversy in the lead section

This has been discussed before (see all four archive files); but not recently, and a new user has been attempting to remove it - so I'll bring it up for discussion again.

The last paragraph of the lead currently states:

Fibromyalgia has been recognized as a diagnosable disorder by the US National Institutes of Health and the American College of Rheumatology.^[20][21] Fibromyalgia, a central nervous system disorder, is described as a "central sensitization syndrome" caused by neurobiological abnormalities which act to produce physiological pain and cognitive impairments as well as neuro-psychological symptomatology.^[1] Despite this there is controversy as to the cause and nature of fibromyalgia. Rheumatologists, neurologists, and pain specialists tend to view fibromyalgia as a pathology of both biological and neurobiological origin. Psychiatrists often view fibromyalgia as being a type of affective disorder, and specialists in psychosomatic medicine tend to view fibromyalgia as being a somatoform disorder. The controversies involve both healthcare specialists as well as patients, who often object to fibromyalgia being described in purely somatic terms.^[22][15]

The new user has been removing the material starting at "Despite this there is controversy ..."[1][2][3][4]

This removal has thus far been reverted, in part due to prior established consensus, and partly due to WP:LEAD which states: "The lead should be able to stand alone as a concise overview. It should define the topic, establish context, explain why the topic is notable, and summarize the most important points—including any prominent controversies."

The question then becomes: does the controversy in the lead here become a WP:WEIGHT issue? I could see an argument to condense it somewhat, keeping the first and last sentence (the last sentence could then be tweaked to better emphasize that different fields view it differently) - but otherwise it seems a reasonable summary to include in the lead. --- Barek (talk • contribs) - 21:04, 14 August 2013 (UTC)

The controversy should definitely be discussed in the lede, as it is important. If the user wants to condense the summary in the lede that is fine, but I don't think it should be deleted. Perhaps the user can discuss here instead of reverting again. --sciencewatcher (talk) 21:15, 14 August 2013 (UTC)

Agree with above by Sciencewatcher. Ward20 (talk) 23:55, 14 August 2013 (UTC)

I would like to repeat my point that NO other wikipedia article I am aware of has such an extensive and convoluted lede, The intital paragraph itself states the cause is UNKNOWN, even mentioning suggested psychological sources as well as comorbidity, But yet the Fibromyalgia article holds Special significance in that Barek and Sciencewatcher feel the need to protect an overly stated and cited lede paragraph section that is repeated as follows:

Rheumatologists, neurologists, and pain specialists tend to view fibromyalgia as a pathology of both biological and neurobiological origin. Psychiatrists often view fibromyalgia as being a type of affective disorder, and specialists in psychosomatic medicine tend to view fibromyalgia as being a somatoform disorder. The controversies involve both healthcare specialists as well as patients, who often object to fibromyalgia being described in purely somatic terms.^[22][15]

and again under the controversy section with slight additions.

Rheumatologists, neurologists, and pain specialists tend to view fibromyalgia as a pathology due to dysfunction of muscles, connective tissue as well as being due to functional abnormalities in the central nervous system. On the other hand, psychiatrists often view fibromyalgia as being a type of affective disorder whereas specialists in psychosomatic medicine tend to view fibromyalgia as being somatoform disorder. However, there is extensive research evidence to support the view that the central symptom of fibromyalgia, namely pain, has a neurogenic origin. The controversies don't just involve healthcare specialists but also patients who often object to fibromyalgia being described in purely somatic terms.

Yes they aren't "exactly" alike but it's close enough. To weigh the article, especially since its the only one on wikipedia like it.

The consensus is also questionable since this has been brought up 5 times now. If agreement was reached why does it keep recurring? If those feeling the disease itself is so controversial, why is it they focus ONLY on this particular disorder, and not any other controversial diseases/issues on wikipedia? It does make me for one wonder if they have some particular agenda they are pushing. Especially since the debate has gone on so long, and keeps recurring over and over again.

I deleted it because the same material appears under the specially created Controversy header, with the same information in expounded form.

But to placate you I would have no objection to something like:

"Fibromyalgia has controversy regarding the source of its pathology, as well as how its sufferers are categorized/diagnosed under those with differing opinions of the disease in the medical community."

or something else not repetitiously battering the reader with excess information in the lede that does not push some agenda. If there are other articles like this I haven't seen them. Repairwiki (talk) 00:15, 15 August 2013 (UTC)--Repairwiki (talk)

The point is that fibro is highly controversial. That the about the only thing that everybody agrees on! Other illnesses such as CFS and MCS are very controversial, and for those illnesses the controversy also appears in the lede. If you want to rewrite the controversy paragraph in the lede then that's fine - go ahead - but it shoudn't be deleted.

The fact that the lede is very long shouldn't be an excuse to delete an important paragraph. I don't really have any opinion as to whether it is too long or not. If you wanted you could shorten the whole lede, but I'd recommend discussing here first. --sciencewatcher (talk) 13:39, 15 August 2013 (UTC)

I would love to see your information on how Fibro is "highly" controversial verse being merely very controversial like CFS and MCS. As it just seems to back up the idea that certain people have an agenda to near persecute those with the disease itself. Chronic Fatigue has its own page on controversy, yet fibro does not.

But as I stated earlier I guess I will shorten the controversy section in the lede since it just restates the information that's in the dedicated controversy section instead of Summarizing it as per WP:LEAD

How does this sound?

Despite this there is controversy as to the cause and nature of fibromyalgia, as well as how patients are described by those with differing opinions of the disease in the medical community. --Repairwiki (talk) —Preceding undated comment added 02:06, 16 August 2013 (UTC)

I thought the first version that was presented for change in this section was preferable.Ward20 (talk) 11:35, 16 August 2013 (UTC)

I agree with Repairwiki that the lead is too long. I would suggest that the first sentence would be enough: Despite this there is controversy as to the cause and nature of fibromyaliga. If the reader needs more information, he or she knows where to find it.98.207.197.166 (talk) 04:43, 18 August 2013 (UTC)

The original paragraph on the controversy in the lead was fine and a balanced summary of the issue and article content and should not have been changed. The controversy about fibromyalgia is very notable and deserves more than a single sentence.--MrADHD | T@1k? 12:46, 18 August 2013 (UTC)

Then lets compromise and go with this sentence: Despite this there is controversy as to the cause and nature of fibromyalgia, as well as how patients are described by those with differing opinions of the disease in the medical community. It conveys the basic information without getting into too much detail. Detail belongs in other parts of the page. 98.207.197.166 (talk) 19:08, 19 August 2013 (UTC)

Can someone clarify which source supports the original paragraph? I'm having trouble finding that language. 98.207.197.166 (talk) 06:38, 22 August 2013 (UTC)

Can someone add this: http://guardianlv.com/2013/06/fibromyalgia-mystery-finally-solved/

I am not usually editing medical articles, I don't want to mess the article up. Can someone else add this? http://guardianlv.com/2013/06/fibromyalgia-mystery-finally-solved/ --helohe (talk) 09:55, 26 June 2013 (UTC)

So apparently someone has 'solved fibromyalgia' by looking at a single patient. Amazing! --sciencewatcher (talk) 16:26, 26 June 2013 (UTC)

Actually 24 patients -- the basis for this is PMID 23691965. As a primary research study that's not a good source per WP:MEDRS, though. The news stories are based on a press release from Integrated Tissue Dynamics LLC, the biotech company that carried out the research, which makes them an entirely unreliable source. In short, this may turn out to be valid but we can't use it yet. Looie496 (talk) 17:06, 26 June 2013 (UTC)

I think this speaks to the same basic idea from another source, I won't add anything as I'm not terribly familiar with medical pages but thought this might be helpful at least in suggesting a potential cause. http://communities.washingtontimes.com/neighborhood/steps-authentic-happiness-positive-psychology/2013/oct/17/fibromyalgia-solved-pathology-not-mind/ — Preceding unsigned comment added by 96.48.16.57 (talk) 16:53, 22 October 2013 (UTC)

Here is another link: http://scicasts.com/bio/6165-researchers-discover-a-rational-source-of-pain-in-the-skin-of-patients-with-fibromyalgia/ — Preceding unsigned comment added by 109.104.30.56 (talk) 14:25, 31 December 2013 (UTC)

Diagnosis

Could someone please add the 6 Fibromyalgia Rapid Screening Tool (FiRST) questions? {{subst:UUnsignedIP|96.23.250.17|07:30, 9 January 2014 (UTC)}}

Fibromyalgia: New Criteria Improve Diagnosis

Diedtra Henderson

Fibromyalgia: New Criteria Improve Diagnosis

February 13, 2014

Medscape Medical News

http://www.medscape.com/viewarticle/820613?src=wnl_edit_medn_wir&uac=70451CR&spon=34 — Preceding unsigned comment added by 99.190.133.143 (talk) 04:22, 15 February 2014 (UTC)

Textbook of pediatric rheumatology

RAS2525, would it be possible to give a page number for that reference you added? Also if you could provide a reference for the actual study being referred to in the textbook, that would be great. --sciencewatcher (talk) 17:45, 2 February 2014 (UTC)

Sciencewatcher - Yes, sorry! A bit new to this. Textbook is at work, but feel free to remove until I can get the page number and cite properly. — Preceding unsigned comment added by RAS2525 (talk • contribs) 19:31, 15 February 2014 (UTC)

Review articles

I just read the following review articles (and comment), and came here to see what Wikipedia said.

http://www.fibrowellnesscenter.com
Dr. Kenneth Muhich
Publication: Fibromyalgia: Falsehoods, Fakers & Facts
ISBN-10: 0989279103
— Preceding unsigned comment added by 70.190.113.238 (talk) 04:16, 22 June 2014 (UTC)

http://jama.jamanetwork.com/article.aspx?articleid=1860480
Daniel J. Clauw
Fibromyalgia: A Clinical Review
April 16, 2014 JAMA. 2014;311(15):1547-1555. doi:10.1001/jama.2014.3266.

http://www.bmj.com/content/348/bmj.g1224
Anisur Rahman, Martin Underwood, Dawn Carnes
Clinical Review: Fibromyalgia
BMJ 24 February 2014

http://www.bmj.com/content/348/bmj.g2168
Letter
Fibromyalgia: an unhelpful diagnosis for patients and doctors
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2168
19 March 2014
Christopher Bass, Max Henderson

I think a good review article in JAMA or BMJ, especially taken together with letters and editorials, is a good authoritative source of the medical consensus. I think it would be better if this article followed these recent review articles more closely. A lot of the citations here are quite old, and there's been a lot of research since then. You can't depend on the accuracy of a 1988 article. In molecular genetics, you can't depend on a 2013 article. The JAMA and BMJ articles address a lot of these issues more precisely, because there have been new RCTs and meta-analyses done since these old articles were written. I also think the JAMA and BMJ articles do a better job of summarizing the issues clearly.

In particular, according to Clauw and Rahman, a key mechanism is the centralized pain state -- the abnormal amplification of afferent pain signals in the spinal cord. People with fibromyalgia feel more pain in response to stimuli than would normally be expected. They've got some good data, like the failure to respond to opioids. It's misleading to say that "Its exact cause is unknown but is believed to involve psychological, genetic, neurobiological and environmental factors." We now have a much better idea of the mechanisms.

And that illustration of tender points is outdated, misleading and wrong. The tender points aren't important to the diagnosis any more. The 1990 ACR criteria were superseded by the 2011 ACR preliminary diagnostic criteria, as Clauw explains. Among other problems, men rarely meet the tender point critera, even though they clearly have fibromyalgia. --Nbauman (talk) 03:00, 19 April 2014 (UTC)

I say go ahead and make some changes. I agree that newer studies would improve this page. Spdem2 (talk) 21:17, 23 April 2014 (UTC)

Controversy in the Intro

I removed the quote about Dr. Wolfe. It seems like it would fit better in the controversy section since his views are controversial.--2601:9:3780:31A:39D9:319A:834F:DAA1 (talk) 19:21, 24 May 2014 (UTC)

Yes agree. The popular press is not a suitable source for comments on if a disease does or does not exist. Especially not in the lead. We need to follow WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:13, 27 May 2014 (UTC)

Doc James, due to an edit conflict, I didn't realize you were editing this issue. I resolved the conflict by also adding the content to the controversies section. (See my edit summary for the edit.) Since this is not a matter governed by MEDRS (it's about the controversy), the source is perfectly proper and is reliable for such a statement. -- Brangifer (talk) 06:27, 27 May 2014 (UTC)

Okay I guess that works. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:29, 27 May 2014 (UTC)

Now that it is in the controversy section, I am removing it from the lead. It doesn't need to be in both places.--2601:9:3780:31A:A013:5DA1:1013:7F3F (talk) 17:47, 27 May 2014 (UTC)

That's not a legitimate argument for removing it from the lead, since every single thing and reference in the lead MUST have already been included in the body of the article, ergo it's ALL duplication. This happens to be a very significant type of objection, and different from many other objections. Considering who it's from, it still belongs in the lead, but your rewording is better, so I'll use it, and I'll place it in a better location. -- Brangifer (talk) 05:03, 28 May 2014 (UTC)

That definitely reads better. I wonder if the second sentence in that paragraph belongs somewhere else in the article. Does it really fit? Also, I found a more recent article about Dr. Wolfe's views and revised the intro to reflect it.--2601:9:3780:31A:A073:7E40:92FA:39CA (talk) 07:27, 28 May 2014 (UTC)

Given the original citation agreed by consensus, with the wording discussed in here, was removed by the IP user while (assuming good faith) adding the new citation, I've restored it using the most recent agreed wording rather than my original. I added a reference to the newer interview and also replaced an "instead" with "involving" to try to refer to both in the summary while remaining concise. The full descriptions of both now remain in the controversies section. vsync (talk) 00:56, 2 November 2014 (UTC)

The original quotation was updated with Dr. Wolfe's latest viewpoint, and consensus was reached back in May on this. I'm not sure why you'd revert this change to go to an outdated source six months later and call that consensus. 2601:9:4480:645:B063:6AEF:5182:6D45 (talk) 10:46, 21 November 2014 (UTC)

You conveniently removed one quote while adding another. My edit took care to make the wording in the lead more general and cite both. The agreement by all was that the quote belonged and the argument to remove from the lead was specious. Your description of what you did, after that discussion and the changes made accordingly, is somewhat vague unless someone looked at the diff. Why do you want so badly for this quote to go away? I have no problem with the one you found. vsync (talk) 17:52, 29 November 2014 (UTC)

I believe you have it exactly backwards. You seem to badly want a quote from 2008 from the NY Times in the lead of an article. This seems like WP:UNDUE and fails WP:MEDRS. If this is the new standard, then a lot of other things that have been reverted should be restored to this article. The old quote may belong in controversies, but it doesn't merit being in lead. Again, it has been this way for six months before you decided it need to be restored. 2601:9:4480:645:C88D:79AA:3F6A:7DD9 (talk) 17:27, 1 December 2014 (UTC)

NPOV

As discussed below in the section mentioning journal articles, "fibromyalgia" as a diagnosis is quite controversial. There is only a small section on the (considerable) controversy, and the article reads like it is written by and for fibromyalgia advocates.

Suggest a re-write citing appropriate (i.e., peer reviewed medical journal) sources. — Preceding unsigned comment added by 72.22.165.146 (talk) 02:35, 6 May 2014 (UTC)

Aside from the size of the controversy section size (which would be an issue of WP:UNDUE more than POV), can you point to where "the article reads like it is written by and for fibromyalgia advocates"? EvergreenFir (talk) 02:45, 6 May 2014 (UTC)

"Evergreen," the ENTIRE article is pretty much pro-fibro. It's clearly evident. Anyone who comes here to question the so-called diagnosis doesn't have a comparison to the facts. Blondesareeasy (talk) 07:04, 18 November 2014 (UTC)

FYI, many of my comments against "fibro" have been eliminated by EvergreenFir, stating the "rules" that this is not a forum to discuss the facts. Again, her suggestion to you to support the obvious kind of points to making this entirely a pro-fibro article verbatim with no friendly discussion. Suspicious to me. I'm asking for proof of the facts. No return on this request other than deleting my statements that fibro just isn't that credible. Blondesareeasy (talk) 02:00, 5 December 2014 (UTC)

Why does "fibromyositis" redirect here?

Term not used in article. 31.53.185.104 (talk) 16:03, 3 January 2015 (UTC)

External Links

As per WP:EL, external links should be limited to one or two very definitive resources. I'm saving the list here as some might be usable as sources for the actual article.

• Fibromyalgia Professional Resource Center from the National Fibromyalgia Association] - previous link was a spam redirect; correct links might be www.fmcpaware.org or www.fibrocenter.com/fibromyalgia-guide.aspx.
• fibromyalgia-cme: this link removed because it's basically a dead page, no content except a title
• Living with Fibromyalgia: Two Drugs Approved at US Food and Drug Administration: definitely not an appropriate EL, could be used a source
• [Fibromyalgia Treatment Guidelines] Published by US Department of Health & Human Resources
• {{dmoz|/Health/Conditions_and_Diseases/Musculoskeletal_Disorders/Connective_Tissue/Fibromyalgia/}}
• Arthritis – Types – Fibromyalgia by the CDC
• Fibromyalgia in Children and Teens
• National Institute of Arthritis and Musculoskeletal and Skin Diseases - US National Institute of Arthritis and Musculoskeletal and Skin Diseases

--Karinpower (talk) 17:30, 7 March 2015 (UTC)

Trimmed a few Doc James (talk · contribs · email) 17:44, 7 March 2015 (UTC)

This is looking better. We are still not within the WP guideline of 1-2 EL's but at least all of these are now fairly appropriate. --Karinpower (talk) 19:15, 7 March 2015 (UTC)

new research reveals cause

could someone please edit the page to include info from the following article in the Guardian? http://guardianlv.com/2013/06/fibromyalgia-mystery-finally-solved/#cbJ5wqgI8QklQTMQ.01 — Preceding unsigned comment added by 105.227.207.214 (talk) 15:50, 21 May 2015 (UTC)

This is an excellent example of why newspapers are not considered reliable sources for medical information. That article is almost two years old, and the study that it describes has received minimal attention in the meantime. In short, it does not meet the criteria in WP:MEDRS. Looie496 (talk) 18:33, 21 May 2015 (UTC)

ICD codes, infobox vs. main text

About this edit, I do not strictly disagree with the edit summary. I just disagree with deleting from the infobox.

"ICD-9-CM 729.1", implies to be that 729.1 is the code for fibromyalgia. And that this code is included in the infobox. It just isn't just for it. The newer code is. I see no harm in including the official name for the code with it. It might not be the rule of WP for these infoboxees, I don't know. What's the harm? comp.arch (talk) 16:50, 26 July 2015 (UTC)

If you are attached to it I guess we can return it. IMO the infobox should be kept shorter. Doc James (talk · contribs · email) 14:25, 28 July 2015 (UTC)

SSRI Treatment

2015 Cochrane review found that the current evidence does not yet support SSRIs for fibromyalgia, this contradicts the 2009 JAMA meta-analysis and the usefulness of the FDA approved drugs in everything except that SSRIs help fibromyalgia patients with depression.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011735/abstract

How can the two sources be reconciled?

amosabo ^t@lk; 13:40, 10 February 2016 (UTC)

Generally when that happens we just present both sources. --sciencewatcher (talk) 16:16, 10 February 2016 (UTC)

IF the Cochrane review takes further evidence into account (and it may have - six years is a long time) then we go with the most recent review - conclusions do change as more evidence is gathered. If the 2015 review is looking at the same evidence base as the 2009 review but comes to different conclusions, then we do simply juxtapose them and state their contradictory results. . Jytdog (talk) 17:32, 10 February 2016 (UTC)

I have gone back to the JAMA meta-analysis:

We found large effect sizes of TCAs for reducing pain, fatigue, and sleep disturbances; small effect sizes of SSRIs for reducing pain; small effect sizes of SNRIs for reducing pain, sleep disturbances, and depressed mood; and small effect sizes of MAOIs for reducing pain.

The Cochrane review is on SSRIs only and contains an extra 2010 study but otherwise contains the same studies bar one. Their conclusion was:

There is no unbiased evidence that SSRIs are superior to placebo in treating the key symptoms of fibromyalgia, namely pain, fatigue and sleep problems. SSRIs might be considered for treating depression in people with fibromyalgia.

Should we just make the distinction between the types of antidepressants? amosabo ^t@lk; 13:13, 11 February 2016 (UTC)

BRD on 5 April 2016

user:173.162.170.106 made a bold edit. This was reverted by user:Jytdog. I am now asking for a discussion here. Jytdog appears to think that 173.162.170.106 is using advocacy.[5] What is the evidence for this? Milligansuncle (talk) 20:23, 5 April 2016 (UTC)

Hi Milligansuncle! Thank you for raising this issue. I have no particular interest in advocating for low-dose naltrexone. I also have no stake in any pharma companies making naltrexone, nor compounding pharmacies that specialize in low-dose formulations. I do, however, have an interest in advocating for the truth - and the truth is, low-dose naltrexone has been shown to provide therapeutic effect in fibromyalgia in preliminary clinical trials. These trials were summarized in a review paper (secondary source), which is what I was able to cite for my contribution to this page.

I'm not sure why I'm being accused of advocacy. I suspect it is some form of ad hominem attack from Jytdog (Jytdog, feel free to chime in). In my contribution, I am indeed advocating that people do more research into LDN for fibromyalgia, but I would also advocate that people with Celiac disease should avoid gluten. Does that somehow make me biased/impartial? 71.184.73.233 (talk) 23:07, 5 April 2016 (UTC)

Please discuss content, not contributors, on article Talk pages. I'll be happy to discuss the content once you remove that. Jytdog (talk) 23:09, 5 April 2016 (UTC)

I did respond to the post on my user talk page. You have not responded.71.184.73.233 (talk) 00:41, 6 April 2016 (UTC)

Your remarks above ""I'm not sure why I'm being accused of advocacy. I suspect it is some form of ad hominem attack from Jytdog (Jytdog, feel free to chime in)." are inappropriate on an article Talk page, as are MilligaUncle's. Article Talk pages are for discussing article content. User Talk pages and notice boards are for discussing user behavior. I'll just open a new section since this was one is trashed. Jytdog (talk) 01:55, 6 April 2016 (UTC)

LDN

There are a series of IP editors promoting LDN for fibromyalgia.

• first, per our article on low dose naltrexone the overall evidence on LDN is weak and there is a lot of hype around it, so in general we need to be cautious.
• In this dif, 173.162.170.106 added content misrepresenting the source, which "reviews" LDN focusing on two studies (one in 9 people, the other in 30) of LDN in fibromyalgia done by the authors of the review (so it fails WP:INDY, but whatever) and which concludes: "The totality of the basic and clinical research to date suggests that LDN is a promising treatment approach for chronic pain conditions thought to involve inflammatory processes.". The added content said "has been demonstrated to provide therapeutic relief" which is as I said an overstatement: "suggest....promising" is very different from "has been demonstrated to provide". The dif also includes a bunch of mechanism stuff which is WP:UNDUE in an article focused on the condition. We generally don't do this in any management section on any medical condition; it is something we do have a section for in articles about the interventions themselves.

I reverted that, IP 108.49.228.2 added it back, I reverted again, and 173.162.170.106 added it back yet again.

• Doc James then did a big series of edits (here) and this content ended up in the Management/Other section appropriately stated and WEIGHTed: "Preliminary clinical data have demonstrated that low-dose naltrexone (LDN) may provide symptomatic improvement in fibromyalgia." No discussion of mechanism.
• IP 108.49.228.2 then came back in this dif again added content bulking this up with mechanism content, which is UNDUE here. I reverted that and 173.162.170.106 showed up again and restored it, I reverted again per UNDUE and MillgansUncle appeared and restored it, another editor removed it and yet another IP showed up 71.184.73.233, and restored it. It is not clear if these IPs and MilligansUncle are all one human being or separate ones, so it is hard to understand what is going on here. But in terms of WP:MEDMOS and how we generally edit about interventions in articles about medical conditions, the additional content here about mechanism is UNDUE. The one line, sourced to the non-independent review, is sufficient WEIGHT for this. Jytdog (talk) 02:27, 6 April 2016 (UTC)

This is reasonable. I agree with your assessment. For the record, I'm the one who introduced the sentence in question. There was another mention of LDN on fibromyalgia from a while back, but it was removed as part of a consolidation effort by Doc James. I re-added this, as it was a short description of LDN's mechanism, but it has subsequently been removed by a couple of different people, so I see that the consensus is that this sentence is not necessary.

Your section on phrasing is highly subjective. Nothing in the original post was untrue, but I can see that you felt the wording was excessively strong, so rewording it was/is fine.

For the record, it is not a "series of IP editors"...all of the anon edits so far have been by me, from multiple devices. I choose to edit anonymously. I am simply glad to be able to contribute to the public resource that is Wikipedia. 71.184.73.233 (talk) 02:46, 6 April 2016 (UTC)

Thank you for clarifying that all the IP edits were by one person. I am glad the content is settled. Any experienced medical editor in Wikipedia will see as a distortion, a description as ""is demonstrated" of a source that says "suggests...may be promising". This is not "subjective" it is the heart of what we do here as we summarize sources; these kinds of distinctions are very, very important. Please be closer to the source going forward. Thanks. Jytdog (talk) 03:05, 6 April 2016 (UTC)

Tramadol

• The 2012 Canadian Guideline says "Due to lack of evidence opioid use is not recommended by any previous FM guidelines" and than says "A trial of opioids, beginning with a weak opioid such as tramadol, should be reserved for treatment of patients with moderate to severe pain that is unresponsive to other treatment modalities [Level 2 [208, 224], Grade D]."[6]
• NIAMS from 2014 says "For a subset of people with fibromyalgia, narcotic medications are prescribed for severe muscle pain. However, there is no solid evidence showing that for most people narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential that the person taking them will become physically or psychologically dependent on them."[7]
• EULAR is from 2008 [8]

Mentioning tramadol is undue weight for the lead IMO Doc James (talk · contribs · email) 20:11, 5 July 2016 (UTC)

• I think you are confusing Tramadol with strong opioids. There seems to be plenty of evidence that Tramadol is effective, but strong opioids are not. Honestly I think Tramadol deserves its own section under opioids, as it also inhibits the reuptake of serotonin and norepinephrine.
• You don't seem to be neutral on this topic. The evidence is much stronger than a lot of information on this page.

It is not FDA approved for fibromyalgia. The NIH states there is no solid evidence. We have a review that states it is second line. Other weak opioids also have tentative evidence. Doc James (talk · contribs · email) 20:55, 5 July 2016 (UTC)

I changed the lead to reflect that it is second line. Why did you change it? That's directly from the source. Again, you do not seem to be neutral on this topic.

Other weak opioids also have similar tentative evidence. And the more indepth discussion belongs in the body of the text. Doc James (talk · contribs · email) 21:01, 5 July 2016 (UTC)

I'm not sure why you say the evidence is tentative for tramadol. The European League Against Rheumatism reviewed 39 pharmacological intervention studies before recommending Tramadol. Seems like exactly the evidence wikipedia recommends. The latest changes you made are better, but still don't seem fully neutral. 2601:644:100:743B:C31:7A23:907D:6D56 (talk) 21:34, 5 July 2016 (UTC)

That study is outdated, with newer evidence available. Also it doesn't detail any exclusion criteria, and only took into account 2 RCTs which:

One was a high-quality study of large sample size and 13 weeks duration.31 The second was preceded by an open label study and only included responders.30

A 13 week study is far too short to base a recommendation upon, and the second study is even worse than that. I'm not inclined to even give this the benefit of "tentative". Carl Fredrik 💌 📧 21:59, 5 July 2016 (UTC)

Gluten

this diff amps up content about the role of gluten in this condition in a way that is UNDUE based on what is known. Content guessing that undiagnosed reactions to gluten (itself a very fuzzy thing) in an article about a fuzzily defined condition is unhelpful. The addition in the management section is just unhelpful - there are zillions of things that the literature suggest could be tried if X is also present; people have co-morbidities all the time. Jytdog (talk) 19:17, 6 April 2016 (UTC)

In my text: Non-celiac gluten sensitivity or an unrecognized celiac disease may be an underlying cause of fibromyalgia,[45][46] but further research is needed.[46], "unrecognized celiac disease" is a resume of this text from this source (currently removed by Jytdog), published on Nature Reviews Gastroenterology & Hepatology (2014 / 2015 Impact Factor of 12.61):

A case series has shed light on the potential benefits of a GFD in patients with fibromyalgia.71...However, the limitations of these studies are that although coeliac disease was felt to be excluded on the basis of negative serology and absence of villous atrophy, the patients might have had the early stages of coeliac disease (and not NCGS), given that a substantial proportion were HLA-DQ2 and/or HLA-DQ8 positive and showed increased duodenal IEL. NOTE: IEL =intraepitelial linfocitosis or lymphocytic infiltration

This means that these patients most likely have celiac disease, instead of non-celiac gluten sensitivity, and this is not a minority point of view, it is based in current guidelines and current knowledge of celiac disease, as for example "ESPGHAN Working Group on Coeliac Disease Diagnosis; ESPGHAN Gastroenterology Committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition|title=European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease":

4.2. Evidence Statements 4.2.1. The histological features of the small-intestine enteropathy in CD have a variable severity. The spectrum of histological findings ranges from lymphocytic infiltration of the epithelium to villous atrophy. (...) HLA Testing for HLA-DQ2 and HLA-DQ8. HLA testing should be performed in patients with an uncertain diagnosis of CD, for example, in patients with negative CD-specific antibodies and mild infiltrative changes in proximal small intestinal biopsy specimens.

Also, my text "At least a subgroup of patients with fibromyalgia have non-celiac gluten sensitivity or subclinical celiac disease (without obvious symptoms)." is based on this other source, which remains on the actual version:

some authors suggest that at least a subgroup of patients with fibromyalgia could experience subclinical CD or non-coeliac gluten intolerance and describe the benefit of a gluten-free diet on FM symptoms (76-78). (Table I). It has also been hypothesised that noncoeliac gluten sensitivity may be an underlying cause of FM symptoms. Non-coeliac gluten sensitivity is increasingly recognised as a frequent condition with similar manifestations which overlap with those of FM, and the elimination of gluten from the diet of FM patients is recently becoming a potential dietary intervention for clinical improvement. Nevertheless, further research is needed to clarify the role of gluten sensitivity in FM (79).

To clarify, let's take a look to the definition of "subclinical CD" (subclinical celiac disease), from The Oslo definitions for coeliac disease and related terms Gut (Impact factor: 14.66) 2013 Jan;62(1):43-52. doi: 10.1136/gutjnl-2011-301346. Epub 2012 Feb 16.PMID 22345659

Subclinical CD Subclinical CD is below the threshold of clinical detection. The term subclinical has often been used to denote silent CD80e82 or patients with CD and extraintestinal symptoms (and no gastrointestinal symptoms).83 The term has also been used for patients with CD who have clinical or laboratory signs (iron deficiency anaemia, abnormalities in liver function tests, enamel defects, incidental endoscopic features, osteoporosis, etc) but no symptoms.84 As understanding of CD has advanced, new disease associations have been regularly found and populations tested for CD have changed in response. For this reason, what is ‘subclinical’ has changed over time. To provide a stable definition, we specified subclinical CD to be disease that is below the threshold of clinical detection without signs or symptoms sufficient to trigger CD testing in routine practice. (...) This review was based on PubMed literature searches and expert meetings. We aimed to define key concepts relevant to CD and related disorders. The character of the current paper implies that we did not pool any data or use any statistical tools. Instead, we assembled an international team of recognised experts in CD research, discussed definitions and tried to reach a consensus. This approach is similar to that of previous papers on definitions of CD.2e4 As opposed to previous studies,2e4 however, we did not limit ourselves to ‘CD only’ but defined a large number of concepts. In addition, we provide guidance to the scientific and clinical community as to which terms should be used and which should be abandoned. Overall, we evaluated more than 300 papers in detail and all authors participated in the discussion leading to consensus definitions. (...) Our research team was multidisciplinary and was composed of specialists from gastroenterology, pathology, paediatrics, neurology and dermatology.

Nevertheless, I agree to let the section non-celiac gluten sensitivity as it is now. However, there is no reason to delete the section Diet, which also includes more information and not only about GFD.

The same situation occurred on the ADHD page, in which Jytdog removed the information about gluten-free diet, and after a discussion on talk page, it was finally added by Doc James. I will edit agein fibromyalgia page and follow the same pattern as he used, mentioning the number of studies (in this case, there are three) supported by this reliable sources:

Best regards. --BallenaBlanca (talk) 22:38, 6 April 2016 (UTC)

Yes once again with the WP:WALLOFTEXT tldr explanation for why something should get UNDUE weight that is only marginally supported by the sources and way out of whack with the overall literature on the topic of management of fibormyalgia. The content you wanted was not added to the ADHD in anything like the form you originally proposed it. No. Jytdog (talk) 23:04, 6 April 2016 (UTC)

Let's ask again Doc James. I think that this text is correctly ajusted to the sources:

Some nutritional interventions have shown positive effects in people with fibromyalgia, such as nutritional education, weight loss treatments, certain nutritional supplements and specific dietary interventions.

Three studies have documented the improvement of fibromyalgia symptoms with a gluten-free diet in people with non-celiac gluten sensitivity or subclinical celiac disease (with mild or absent gastrointestinal symptoms). A diet rich in antioxidants nutrients may be beneficial. Some evidence has shown a clinical improvement with the elimination of monosodium glutamate from the diet, while other evidence does not.

It includes an explanation of "subclinical CD" so it can be understood by anyone without knowledge of the subject. (definition present, for example, here The Oslo definitions for coeliac disease and related terms Gut (Impact factor: 14.66) 2013 Jan;62(1):43-52. doi: 10.1136/gutjnl-2011-301346. Epub 2012 Feb 16.PMID 22345659)

I have located a link to download one of the sources, so you can read it "Fibromyalgia and nutrition: what news?"

Best regards. --BallenaBlanca (talk) 00:23, 7 April 2016 (UTC)

References

Gluten the great satan, with MSG-scare and antioxidant-hyping stuff to boot. For pete's sake. Jytdog (talk) 00:26, 7 April 2016 (UTC)

Stick with ref 1 and 2. Ref 3 is not great and is hedged re GFD ("might" etc.) Remember also there are many other causes of duodenal lymphocytosis and that DQ2/8 are common. Subclinical disease (however defined) needs more supporting evidence to make it Accepted knowledge in a condition like this. Jrfw51 (talk) 09:10, 7 April 2016 (UTC)

After talk, I have only used the ref 1 PMID 26122473 of Nature Reviews Gastroenterology & Hepatology, with a current impact factor of 12.61, for this edit [9]. No reasons to revert it [10]. I will restore it and because it is a non free-access source, I will add a quotation to avoid further misinterpretations. Best regards. --BallenaBlanca (talk) 09:06, 1 July 2016 (UTC)

It's undue and not very well summarized; you are also edit warring. Once again this is pushing waaaay too much gluten information into articles on other topics. Alexbrn (talk) 09:12, 1 July 2016 (UTC)

You are not exposing compelling reasons. It is a very brief text supported by a reliable source WP:MEDRS, previously accepted per talk. Nevertheless, I will accept a different wording. Let's see how Doc James or Jrfw51 would like to summarize.

I am not edit warring, you are edit warring. An edit war occurs when editors repeatedly override each other's contributions. You have made the first reversion and a second one. I only made one reversion and exposed my reasons here, and I will wait more opinions. And please, avoid personal attacks as saying POV/pushing. Best regards. --BallenaBlanca (talk) 09:47, 1 July 2016 (UTC)

Perhaps try WP:BRD rather than trying to force your text in? Concerns about gluten POV-pushing have been raised before and you professed to take them on board. I am not happy with these large screeds of gluten content being unduly forced into WP particularly when the provisional nature of the research (as even expressed in the source) is not made explicit. Alexbrn (talk) 09:57, 1 July 2016 (UTC)

"Concerns about gluten POV-pushing have been raised before" Yes, and the user is now blocked, but please, leave aside those comments per WP:TPO, avoid personal attacks and let's focus on this issue. Also, the issue is not whether the information about gluten related disorders makes you happy or not, this is not a criterion to revert edits. Best regards. Best regards. --BallenaBlanca (talk) 11:10, 1 July 2016 (UTC)

Many editors at WT:MED expressed concern about a gluten WP:CPUSH. The fact that you know one of them is currently blocked makes this look like a timed intervention. You have mistaken my use of the word "happy" by taking it out of context is which I raised concerns of both WP:WEIGHT and accuracy. Alexbrn (talk) 11:18, 1 July 2016 (UTC)

Let's focus on this issue, please WP:TPO. Best regards. --BallenaBlanca (talk) 11:22, 1 July 2016 (UTC)

The issue remains that we have no answer to the question posed above: why something should get UNDUE weight that is only marginally supported by the sources and way out of whack with the overall literature on the topic of management of fibormyalgia? Alexbrn (talk) 12:12, 1 July 2016 (UTC)

Medicine is a living science. Health articles are full of similar situations, describing new findings, results of studies or new treatment strategies, and is perfectly valid when supported by verifiable sources, as is this case. I tried to write it in the briefest and more aseptic way.

The answers to undue weight are very clear. For example, Wikipedia:Reliable sources and undue weight#Reliability can help judge due weight "The reliability of a source can help you judge the weight to give the opinions of that source. The more reliable the source, the more weight you should give its opinion." --> PMID 26122473 of Nature Reviews Gastroenterology & Hepatology, with a current impact factor of 12.61. It matches with Wikipedia:Reliable sources and undue weight#Main aspects: editorial oversight, attributability, expertise of the originator with respect to the subject, not biased, etc. And about extension, fibromyalgia page have 32,193 characters and my text 192 characters (0.59% of total).

But I will accept a new wording, which is the heart of the matter. Best regards. --BallenaBlanca (talk) 19:18, 1 July 2016 (UTC)

Looks okay as "Tentative evidence found an improvement in symptoms with a gluten free diet among those without celiac disease." for the research section so added there. Doc James (talk · contribs · email) 23:34, 13 July 2016 (UTC)

I agree. Best regards. --BallenaBlanca (talk) 23:52, 13 July 2016 (UTC)

Doc James, can you post the section of the Aziz review that supports your statement, for those of us who don't have access to it? There is no mention in the abstract of any evidence for gluten free trials working for FMS. I had a quick look on gscholar and didn't see any clinical trials. Which trials is this "tentative" statement based on? And if there aren't any controlled trials, is that statement not WP:UNDUE? --sciencewatcher (talk) 23:57, 13 July 2016 (UTC)

The source is a review and the text in the review is about a case controlled trial and case series "A case series has shed light on the potential benefits of a GFD in patients with fibromyalgia.71 In 20 patients with longstanding and fairly debilitating symptom history of fibromyalgia, a GFD was trialled after conventional therapies failed. Coeliac disease was excluded by negative anti-TG2 antibody tests and absence of villous atrophy, although all patients were noted to have increased duodenal IELs. After commencing a GFD, clinical response led to at least one of the following scenarios: remission of fibromyalgia pain criteria; return to work; return to normal life; or discontinuation of opiates. The reintroduction of gluten was followed by fibromyalgia relapse, which subsided upon a GFD.71 Following on, a case–control study evaluated the effects of a GFD in 97 patients with fibromyalgia and coexisting IBS, in which 58 patients had raised duodenal IELs and 39 had normal duodenal biopsies.72 Coeliac serology was negative. At baseline, all participants recorded similar poor quality of life and high fibromyalgia and IBS-related symptom scores. After 1 year on a GFD, all outcome measures markedly improved by 26–30% in the increased duodenal IEL group compared with 3–4% in the normal mucosa group. These results stress the potential role of gluten as a trigger of the clinical manifestations of IBS and fibromyalgia and indicate that increased duodenal IEL might be a useful clue to identify those patients who potentially benefit from gluten withdrawal."

So the evidence is definately tentative. Doc James (talk · contribs · email) 03:16, 14 July 2016 (UTC)

So tentative, I'd say, that it's undue to mention it. The trouble with the word "tentative" is that while EBM types read it as "not well-evidenced at all", lay readers take it to mean we're in the early stages of a breakthrough. Maybe we could say it's "not well-evidenced" or something? Alexbrn (talk) 18:18, 14 July 2016 (UTC)

How about "low quality evidence". Never heard the term "well-evidenced" before Doc James (talk · contribs · email) 21:10, 14 July 2016 (UTC)

Ideas to spread awareness through Wikipedia

Hi! I'm returning to Wikipedia after a long absence due to medical issues and now with a new diagnosis of EDS. I noticed that the Fibromyalgia page on Wikipedia doesn't mention Ehlers Danlos Syndrome, even though a large number of us with FMS are now being diagnosed with EDS as awareness increases. I think it would be very helpful to many people to steer them this way if they show other EDS symptoms. I also noticed there's no mention on this EDS page of Mast Cell Activation Disorders, Including Mast Cell Activation Syndrome, despite it being a common comorbid disorder https://en.wikipedia.org/wiki/Mast_cell_activation_syndrome And there's no mention of that at https://en.wikipedia.org/wiki/Multiple_chemical_sensitivity even though MCS and MCAS strongly appear to be overlapping syndromes by different names. I would like to find supporting studies and link all these things together for people learning about these conditions. I think we could connect A LOT of dots for people suffering from these syndromes, like myself, or people they know with these problems. I keep meaning to do it myself, but I'm in them middle of a lot of medical stuff myself, of course, and I'm relearning how to edit here, too, after many years away, so I'm asking that if anyone would love to make these really significant contributions for the greater good to please feel free to jump on it. Thanks! — Preceding unsigned comment added by AliaZebra (talk • contribs) 01:16, 3 November 2016 (UTC)

Symptoms Image

The symptoms image lists "Multiple chemical sensitivity". It should be removed.Petergstrom (talk) 06:19, 18 November 2016 (UTC)

Why? Doc James (talk · contribs · email) 20:29, 18 November 2016 (UTC)

Because multiple chemical sensitivity isn't a real accepted symptom...its way to vague.Petergstrom (talk) 17:32, 19 November 2016 (UTC)

Not seeing enough issues to justify its removal. Is it really just that one issue you have to justify the images removal? Doc James (talk · contribs · email) 21:32, 28 November 2016 (UTC)

It is a major issue, it is on the level of "vaccines cause autism" and "cancer is caused by misaligned qi". It is quackery.Petergstrom (talk) 22:10, 28 November 2016 (UTC)

Not exactly in that league. While a controversial condition there are some refs that support[11][12] Doc James (talk · contribs · email) 22:49, 28 November 2016 (UTC)

Where is the MEDRS that links MCS with FM? — soupvector (talk) 04:27, 29 November 2016 (UTC)

Ref for the image is this one [13] Doc James (talk · contribs · email) 06:24, 29 November 2016 (UTC)

There isn't one, because no credible source recognizes MCS as real. Petergstrom (talk) 06:05, 29 November 2016 (UTC)

This references lists fibromyalgia as a commonly overlapping condition with MCS.[14] A 2012 3rd addition textbook by CRC Press should be sufficient.

This 2016 textbook from Elsevier also supports [15] Doc James (talk · contribs · email) 06:26, 29 November 2016 (UTC)

Did you even read the sources? They list electromagnetic sensitivities as well as gulf war syndrome, they are obviously not mainstream ideas and not MEDRSPetergstrom (talk) 16:36, 29 November 2016 (UTC)

You will need consensus. And yes they are MEDRS as these are major textbooks. Doc James (talk · contribs · email) 17:05, 29 November 2016 (UTC)

Are you hearing yourself? They listed MAGNETIC HYPERSENSITIVITY! That is on the level of vaccines/autism and homeopathy. Petergstrom (talk) 17:13, 29 November 2016 (UTC)

This ref[16] lists CFS, MCS, fibromyalgia, IBS, and TMJ. Doc James (talk · contribs · email) 18:53, 29 November 2016 (UTC)

Stop trying to justify multiple chemical sensitivity. Its not real. The sources that include it also list magnetic hypersensitivity. MCS is not recognized by the WHO and AMA http://www.chrc-ccdp.gc.ca/sites/default/files/envsensitivity_en.pdf http://www.tandfonline.com/doi/abs/10.3109/15563659509000459 Petergstrom (talk) 21:29, 30 November 2016 (UTC)

I do not care if you take it out of the picture. This is still not justification to remove the picture entirely. User:Mikael Häggström your thoughts as the images creator? Doc James (talk · contribs · email) 21:39, 30 November 2016 (UTC)

I've amended the image to remove mention of MCS and increased the size enough to make the text readable. It can always be reverted if others think MCS should be included. --RexxS (talk) 23:22, 4 December 2016 (UTC)

Sounds good to me :-) Thanks. Doc James (talk · contribs · email) 00:05, 5 December 2016 (UTC)

Data

"A single trial found that hyperbaric oxygen therapy symptoms.Efrati, Shai; Golan, Haim; Bechor, Yair; Faran, Yifat; Daphna-Tekoah, Shir; Sekler, Gal; Fishlev, Gregori; Ablin, Jacob N.; Bergan, Jacob (2015-05-26). "Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome – Prospective Clinical Trial". PLOS ONE. 10 (5): e0127012. doi:10.1371/journal.pone.0127012. ISSN 1932-6203. PMC 4444341. PMID 26010952.{{cite journal}}: CS1 maint: unflagged free DOI (link)" is supported by a single prospective trial. Not even an RCT. Therefore IMO not notable yet. Doc James (talk · contribs · email) 21:48, 25 October 2016 (UTC)

HBOT is at times touted as a universal cure for everything from cancer to PED, but positive trial results are rarely repeatable. Sadly, the opportunity to sell flexible monoplace chambers for off-label use has created an industry that cruelly dangles the possibility of successfully treating difficult ailments, particularly in children, and there's money to be made in uncovering yet another possible candidate condition. In the USA, the Undersea and Hyperbaric Medical Society is tasked with producing a list of conditions that are recognised for reimbursement and that can be found at Hyperbaric medicine #Medical uses. Novel proposed uses of HBOT are really WP:REDFLAG issues, and I'd advise that we shouldn't be reporting them until there's a gold-plated MEDRS source that acknowledges effectiveness in those cases. --RexxS (talk) 01:07, 5 December 2016 (UTC)

Dopamine function

Should I add two primary source receptor binding studies for the dopamine section? https://www.researchgate.net/publication/283261838_Differential_dopamine_function_in_fibromyalgia https://www.ncbi.nlm.nih.gov/pubmed/17610577 — Preceding unsigned comment added by Petergstrom (talk • contribs) 21:30, 1 December 2016 (UTC)

Tramadol Opinion

Have wikipedia standards changed? Why would we leave an opinion statement in the article when there is no evidence to support it? Why are people reverting without using the talk page? — Preceding unsigned comment added by 2601:644:100:743B:1067:3BB8:BBBF:C702 (talk) 08:03, 4 December 2016 (UTC)

Because the source, Goldenberg, DL; Clauw, DJ; Palmer, RE; Clair, AG (May 2016). "Opioid Use in Fibromyalgia: A Cautionary Tale". Mayo Clinic Proceedings (Review). 91 (5): 640–8. doi:10.1016/j.mayocp.2016.02.002. PMID 26975749., is a review - that is a secondary source - and is published in a highly reputable journal. That makes it a reliable source. It states "There is evidence that tramadol may be effective in the treatment of FM, but it is considered a weak opioid receptor agonist, and its efficacy in FM is likely related to its other mechanism of action as a serotonin-norepinephrine reuptake inhibitor." and all you have to do is click on the link http://www.mayoclinicproceedings.org/article/S0025-6196(16)00102-6/fulltext to read it for yourself.

Claims made by a reliable secondary source which are not contested by another equally reliable source are facts as far as Wikipedia is concerned, not opinions. I took the trouble to attribute the source and used the verb 'suggested' as the authors only stated it was "likely". The article text for comparison is "Goldenberg et al suggest that tramadol works via its serotonin and norepinephrine reuptake inhibition, rather than via its action as a weak opioid receptor agonist.{ref the above paper}" Now if you have any policy-based reason to object to the text, state it, otherwise I'll ask for admin action to prevent you from further edit-warring and disruption. --RexxS (talk) 15:43, 4 December 2016 (UTC)

The review also states this: "This review is, therefore, limited to traditional opioid analgesics, and tramadol is not included." So the review even states they did not study Tramadol, so the statement is pure speculation, not based on studies. I welcome further admin action, as you reverted my change without even using the talk page. I am attempting to be bold and eliminate text that is not supported. I'm not sure why you would call that edit-warring or disruption. — Preceding unsigned comment added by 2601:644:100:743B:1067:3BB8:BBBF:C702 (talk) 21:36, 4 December 2016 (UTC)

No, the review states that it was designed to survey the use of opioids in FMS, based on the proposition that the mechanism of action of traditional opioids predicts their lack of efficacy in FMS. It carefully explains that tramadol is excluded from the survey precisely because it does have an effect on FMS, citing pmid:12753877, pmid:9604730 and pmid:19078481. The authors then explain that tramadol's other mechanisms of action are the likely reasons for its efficacy, citing pmid:16762044 and pmid:12753877. That is a conclusion reached by expert authors, a secondary source, and published in Mayo Clinic Proceedings, which makes it a reliable source. You cannot draw the conclusion that because the authors decided to exclude tramadol from the opiods reviewed, they cannot have anything at all to say about tramadol. Indeed, we put such great store on secondary sources because we accept the ability of the authors to reach conclusions that are informed by their expertise in the field, and allow them to determine the weight that their sources should have. We don't know what sources authors are familiar with, nor is it our place to pass judgement on their status as subject experts. On the contrary, Wikipedia sourcing policies require us to acknowledge the conclusions of authors expressed in relevant reliable secondary sources. Your assertion that "the statement is pure speculation, not based on studies" is utter nonsense, as anybody can follow the links to at least two of the studies that the authors deemed important in reaching their conclusion. Your bold edit [17] was baseless and your subsequent re-reverts [18][19], against two different editors, increasingly ill-judged. The repeated attempts to impose your preferred version is edit-warring; and your attempt to exclude properly sourced content – based on the misconception that your opinion overrides the conclusion of a secondary source – is disruptive. Has that clarified it for you? --RexxS (talk) 22:54, 4 December 2016 (UTC)

Agree with User:RexxS Doc James (talk · contribs · email) 00:07, 5 December 2016 (UTC)

I am going to try to cleanup the pathophysiology sectionPetergstrom (talk) 18:12, 9 January 2017 (UTC)

Genetic feature?

Most of the symptoms would be useful for knights on horseback wearing a full suit of armour. Like increased sensitivity to sound and pressure, less energy spent on walking. — Preceding unsigned comment added by 195.195.236.131 (talk) 16:21, 8 February 2018 (UTC)

Not sure you understand how genetics work. Also the increased sensitivity (at least in my case) would not be a benefit. On days when it's bad, the pain it induces is crippling. Also I struggle to walk normally, I wouldn't stand a chance if you added a 50kg (110 lbs)suit of armour to the equation. Leeraven172 (talk) 13:57, 15 February 2018 (UTC)

No critique allowed

This article seems to be intentionally devoid of any criticism of "fibro." Lacks a LOT of balance in that aspect. Indeed, this is a disservice to the Wiki Community. Blondesareeasy (talk) 22:49, 1 January 2017 (UTC)

Not sure what you mean? Doc James (talk · contribs · email) 09:26, 10 January 2017 (UTC)

Which other disease / illness entries in Wikipedia contain criticism? Leeraven172 (talk) 13:53, 15 February 2018 (UTC)

What other diseases/illnesses are considered speciuos by medical science? — Preceding unsigned comment added by 2602:306:CF99:2080:186B:1E07:4BE0:9E1B (talk) 15:10, 14 August 2018 (UTC)

Please replace the photo of the naked woman

There are many educational images of fibromyalgia that do not feature a naked woman. We almost never see photos of naked males and I don't feel it is appropriate for Wikipedia to display these kinds of photos in the guise of education. Mindykw (talk) 14:53, 24 January 2019 (UTC)

I don't think this image is overtly sexual, but more importantly, you would need to provide a copyright free image, to replace it with, not just something you found on the internet, or in a book or other publication - Arjayay (talk) 15:51, 24 January 2019 (UTC)

They must be joking, right?Roxy, the dog. wooF 15:53, 24 January 2019 (UTC)

Primary Graphic and Gender Issue

I have two concerns. First, I don't feel that the 'tender points' graphic from 1990 is at all helpful - in fact, it is harmful as it perpetuates the idea of that being the proper way to diagnose fibromyalgia and that it is representative of where people who suffer from it (such as myself) hurt. It has been scrapped, as the article mentions, in favor of a more holistic diagnosis approach including the WPI - but also asking about things pertaining to fibro fog, anxiety, flares and triggers, etc. Perhaps the WPI image is acceptable, certainly better (the current tender points graphic should be in the history of the illness section, still!). I'm not well versed in how to edit wikipedia anymore, especially images, so I leave this up to debate and someone else's skill.

Second, the social section ought to have a discussion of gender. As someone who has taught on gender and politics many times, I find myself in a strange position arguing that this article - like most on fibromyalgia - is overly gendered, making it sound like a 'woman's disease' without addressing the social aspects of this. 10 - 25% of those who have fibro are men, and we suffer too (often differently, as well - one reason the tender points test is no longer the main diagnostic tool). I could write something up later, perhaps, but would like to at least hear others' input.RememberToForget (talk) 00:20, 19 July 2019 (UTC)

Chronic fatigue syndrome

Not sure why this was removed? Doc James (talk · contribs · email) 04:07, 24 December 2019 (UTC)

Frontiers Media

There are concerns that Frontiers Media journals are predatory. This is a fairly significant claim "Neuroinflammation with involvement of mast cells is believed to play an important role in fibromyalgia, with stress contributing to flare ups in symptoms." and we should have stronger source. Doc James (talk · contribs · email) 14:22, 27 December 2019 (UTC)

Okay, fair enough.--Literaturegeek | T@1k? 15:25, 27 December 2019 (UTC)

Moving here

"The most recently pathophysiology of fibromyalgia is a neuroinflammation, which is proven by increased translocator protein (TSPO) and microglia activation.Marco L.Loggia, Daniel S.Albrechta (14 September 2018). "Brain glial activation in fibromyalgia". Brain, Behavior, and Immunity. 75: 72–83. doi:10.1016/j.bbi.2018.09.018. PMC 6541932. PMID 30223011."

This ref is a small primary source and does not support the claims in question. Doc James (talk · contribs · email) 11:51, 29 December 2019 (UTC)

"Research teams find widespread inflammation in the brains of fibromyalgia patients". ScienceDaily. 27 September 2018. Retrieved 27 December 2019.

Also popular press

"Mass General Researchers Identify Pattern of Brain Inflammation in Fibromyalgia Patients". Mass General Research Institute. 4 December 2018. Retrieved 27 December 2019."

Doc James (talk · contribs · email) 11:51, 29 December 2019 (UTC)

User:GustavoTemple I have moved this to the research section until covered by a proper secondary source. Doc James (talk · contribs · email) 11:55, 29 December 2019 (UTC)

I agree with Doc James that this shouldn't go in the article yet. It might be true, but so many researchers have declared that they know the cause in the past, that we're slow to take up "new" ideas, and we almost never cite the primary literature. Neuroinflammation is mentioned in some recent review articles, but they seem to understand neuroinflammation as one of several components. The understanding is that "neurogenic neuroinflammation might contribute to the multifactorial pathogenesis", to quote one review article. Neuroinflammation is not the whole story.

If you have an academic background, then you might find it useful to read Wikipedia:Ten simple rules for editing Wikipedia. WhatamIdoing (talk) 23:33, 29 December 2019 (UTC)

Not a cause

This "The cause of fibromyalgia is a neuroinflammation, which is proven by increased translocator protein (TSPO) and microglia activation."

Is not a cause but a mechanism. Also we need to use high quality secondary not primary sources. Doc James (talk · contribs · email) 04:11, 24 December 2019 (UTC)

References

’Proven’ sounds argumentative, would prefer ‘demonstrated’ or ‘confirmed’.--Literaturegeek | T@1k? 04:22, 24 December 2019 (UTC)

https://www.sciencedirect.com/science/article/abs/pii/S0306987719303263

MRIdye.com gave me fibromyalgia. Largest historic breach of Helsinki. Gadisbad (talk) 22:18, 21 January 2020 (UTC)

Duplicate image

The same image appears twice, with the same caption ("The location of the nine paired tender points that constitute the 1990...").

Is there ever a valid reason for the same image to appear twice in an article? I can't think of one. Seems like a waste of bandwidth; and when I started reading the caption a second time, and had to take time to think "hey, didn't I read this same exact thing a little while ago?", this reader really felt that her time had been wasted. 2601:281:CC80:5AE0:E8A4:75E7:E5F2:A517 (talk) 04:34, 15 March 2020 (UTC)

Fibromyalgia

I HAVE SWELLING IN MY LEGS AND ANKLES AND BLOTCHES THAT COME AND GO ...IS THIS PART OF OR A SYMPTOM OF Fibromyalgia KELVIN — Preceding unsigned comment added by 222.152.180.185 (talk) 23:24, 9 May 2020 (UTC)

Image of symptoms

This was removed? Not sure why? Doc James (talk · contribs · email) 05:21, 11 May 2020 (UTC)

"famciclovir + celecoxib"

I posted this:

Famciclovir and celecoxib may be effective in reducing fibromyalgia related pain. These medications' mechanisms are thought to suppress latent herpes virus infection which some fibromyalgia patients are theorized to suffer from.

But it was removed by doc james with the following reason: "Need secondary source, was not compared to celecoxib alone but placebo"

If anyone comes across a secondary source maybe my point can be added --Hiveir (talk) 20:15, 16 May 2020 (UTC)

References

Misdiagnosis section?

Should this be considered under controversy? For example, one study supports the potential of 19% of FM patients have laboratory findings suggestive of another (although possibly concurrent) disease. https://acrabstracts.org/abstract/hypophosphatasia-may-be-misdiagnosed-as-fibromyalgia-a-single-center-experience/ Mlepisto (talk) 10:13, 5 January 2021 (UTC)

Immune system

Link to the immune system found via mice? The Guardian and Journal of Clinical Investigation. Gaia Octavia Agrippa ^Talk 11:21, 6 July 2021 (UTC)

Would need WP:MEDRS. Alexbrn (talk) 11:22, 6 July 2021 (UTC)

Does the JoCI article count as a primary source? Gaia Octavia Agrippa ^Talk 09:40, 7 July 2021 (UTC)

Yes. Alexbrn (talk) 10:38, 7 July 2021 (UTC)

Thanks Alexbrn, Gaia Octavia Agrippa ^Talk 10:50, 7 July 2021 (UTC)

Inaccurate image

The image presented is outdated and represents the old diagnostic method (prior to 2016). I suggest replacing it with this image. The image represents the 19 pain areas used to diagnose Fibromyalgia using the Widespread pain index (WPI). SigTif (talk) 05:35, 10 August 2021 (UTC)

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Parkla. Peer reviewers: Parkla.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 21:22, 16 January 2022 (UTC)