Fibromyalgia: An acceptable diagnosis?

Background: Neither patients nor clinicians and researchers fully embrace the fibromyalgia diagnosis. A core objection relates to the huge overlap with other polysymptomatic distress disorders such as somatic symptom disorder and chronic fatigue syndrome. Another objection has to do with the classification of fibromyalgia as a rheumatic disease, which may hamper research and treatment of psychosocial factors.
Objectives: To get insight into the pros and cons of the fibromyalgia diagnosis.
Methods: The scientific literature was reviewed with a focus on homogeneity and heterogeneity within the group diagnosed as fibromyalgia.
Results: That fibromyalgia is not a stable diagnosis of a homogeneous group is reflected in the ongoing development of new classification and diagnostic criteria; the newest including diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms (Arnold et al., 2019). Moreover, treatment recommendations progressed from a focus on pharmacological treatment in 2008 to a focus on nonpharmacological therapies in 2017 (Macfarlane et al., 2017). Also, several studies showed that the group is quite heterogeneous with respect to type, number and severity of symptoms and comorbidities (e.g., Davis et al., 2018) as well as with respect to adaptation profiles covering a spectrum of severely maladjusted to quite well adjusted in terms of objective and subjective management (Estevez-Lopez et al., 2018).
Conclusion:
Although diagnostic classifications such as fibromyalgia help to examine underlying mechanisms and interventions and to define treatment recommendations, in clinical practice and research account should be taken of heterogeneity of patients in terms of symptoms and disorder-transcending biopsychosocial factors that influence the disorder. This suggests that fibromyalgia is an acceptable diagnosis to the extent that individuality is accepted as part of the diagnosis.

Arnold et al. AAPT Diagnostic Criteria for Fibromyalgia. J Pain 2019, in press.
Davis et al. Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome. J Pain Res 2018;11:2551-60.
Estevez-Lopez et al. Adaptation profiles comprising objective and subjective measures in fibromyalgia: the al-Andalus project. Rheumatology (Oxford) 2017;56:2015-24
Macfarlane et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017;76:318-28.