Fibromyalgia syndrome, a problem of tautology
Abstract
Fibromyalgia syndrome is generally taken to denote a clinical state of widespread musculoskeletal pain, stiffness, and fatigue but its pathophysiology, physical and psychological, is unknown, and the nature of the diagnostically mandatory "tender points" remains obscure. Diagnostic criteria convey no pathophysiological insight and they have been "validated" via a circular argument in which the evidence on which the construct is based is taken as proof of its veracity. The concept of fibromyalgia syndrome is valid only in the sense that it includes all possibilities. An alternative approach to this very real clinical presentation is via secondary hyperalgesia.
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The ACR classification criteria, rightly criticized for circularity, created a de facto case definition by imposing the 11 tender point rules on top of a crude definition of widespread pain.
“The ACR classification criteria, rightly criticized for circularity (16), created a de facto case definition by imposing the 11 tender point rules on top of a crude definition of widespread pain (17).”
From The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity (2010) · cites this paper as [16]
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- Authors
- Cohen, M. L., & Quintner, J. L.
- Affiliations
- UNSW Sydney (AU)
- St John of God Health Care (AU)
- Corresponding author
- Cohen, M.L
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1993-10
- Volume
- 342
- Issue
- 8876
- Pages
- 906-909
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2047444795
- Cited by
- 138
- References
- 28
- Citations by year
- 2026: 2 · 2020: 2 · 2019: 1 · 2017: 1 · 2015: 1 · 2013: 8 · 2012: 1
- FWCI
- 7.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- fibromyalgia, tautology, diagnostic criteria, tender points, pathophysiology, secondary hyperalgesia, chronic widespread pain, fatigue, circular argument, construct validity
- MeSH terms
- Fibromyalgia, Humans, Pain Measurement, Sensitivity and Specificity, Syndrome
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