Abstract
To the Editor: The controversies surrounding fibromyalgia (FM) and the absolute mess the diagnostic label of “fibromyalgia” has created were recently reviewed1–3. Unfortunately, not one of the articles addresses the fundamental problem that exists within the construct of the FM diagnosis: the fallacy of pain from nowhere. While the unifying theme across the 3 articles is that FM is a dead-end diagnosis begging for definition and context, they fail to address the fact that absolutely nobody has actually identified the source of the pain that patients suffer. Clearly, abnormalities in pain-processing with central sensitization to external pain stimulation have been well documented in FM, and it has been widely accepted in standard reviews and textbooks, without argument, that it is from here that FM pain arises4–8. However, there is absolutely no evidence that central sensitization actually causes spontaneous, non-externally stimulated pain. The implication that the pain of FM arises out of a central sensitization syndrome, despite the knowledge that central sensitization is a modification response to actively induced pain and not a source of pain itself9,10, is a true failure of medical science. Central sensitization does not cause pain. It simply modulates pain from a defined, active pain source. Further, there is absolutely no evidence that primary FM is a true central pain syndrome with pain originating from abnormalities of the central nervous system, such as are seen in brain and spinal cord vascular lesions, traumatic injury, tumors, inflammation, and infection; multiple sclerosis; syringomyelia and syringobulbia; epilepsy; and Parkinson’s disease11. … Address correspondence to Dr. Sarkozi. E-mail: jsarkozi{at}fmpolypain.com
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