Correspondence: Dr Manfred Harth, AIM Clinic, 458 Central Avenue, London, Ontario N6B 2E5. Telephone 519-432-1521, fax 519-679-9658, e-mail mharthc593@rogers.com Patients with fibromyalgia suffer from widespread pain and fatigue; their sleep is nonrefreshing (1-3); most experience headaches; and 48% may have migraine (4). Cognitive disturbances are common; other distressing and painful symptoms occur frequently and include irritable bladder, irritable bowel and vulvodynia (1-3). In one study of community cases of fibromyalgia (5), approximately one-half of the individuals examined were found to have high state and trait anxiety scores, and high scores for depression. Many patients with fibromyalgia are unable to engage in gainful employment; in one study in the United States, 26% received disability payments, as did the same percentage in a study conducted in Canada (6). Kleinman et al (7) reported data obtained from approximately 700,000 employees from various large self-insured employers in the United States; employees with fibromyalgia incurred significantly higher total health benefit costs, and had a much higher number of days absent from work than employees without fibromyalgia; employees with fibromyalgia also had “significantly lower per-employee annual objective productivity” than employees without fibromyalgia. In addition, patients with fibromyalgia have to shoulder a burden seldom borne by individuals with other medical conditions. Fibromyalgia sufferers are frequently not perceived as having a distressing condition. Their families, their friends and their coworkers are often skeptical of their symptoms or their functional impairment. Kool et al (8) used the term ‘invalidation’, which includes social rejection; they pointed out that invalidation includes not only a lack of understanding and denial, but also “lecturing and over protecting”. A recent study reported on embitterment in 64 fibromyalgia patients who were employed; embitterment was the apparent result of a combination of invalidation and helplessness (9). Rodero et al (10) studied 250 patients with fibromyalgia using the Injustice Experience Questionnaire (IEQ), a measure of perceived injustice. They found that 47.2% of patients had high IEQ scores (>30), which translated to a clinically relevant level of perceived injustice. IEQ scores were significantly associated with global function and pain catastrophizing (10). Briones-Vozmediano et al (11) further explored the relationships between patients with fibromyalgia and their professional health care providers using a qualitative research approach; their report was published in the January/February 2013 issue of Pain Research and Management. Interviews were conducted with 12 patients and nine health professionals, of whom seven were physicians, one was a physiotherapist and one a psychologist. There were nine female and three male patients, ranging in age between 29 and 61 years; five of the 12 were inactive, unfit for work or on sick leave. A feeling of invalidation is expressed, for instance, by patient 7, who stated: