Fibromyalgia — master index¶
Last curated: 2026-08-28 · 19 wiki pages (18 audited curated, 1 draft) · 392-paper master bibliography · 15 landmark-paper notes · guidelines registry (25 documents + 5 regulatory decisions) · statistics sheet (~85 criteria-stratified figures) · 70 verified clinical trials · 14 patient organizations verified worldwide · 29 open research questions + 12 unconnected-dots junctions
The condition in five sentences. Fibromyalgia is a common chronic disorder of widespread pain with fatigue, non-restorative sleep, and cognitive symptoms — the paradigm case of "nociplastic" pain, the third mechanistic pain category beside nociceptive and neuropathic. It has no confirmatory test: six diagnostic criteria sets are simultaneously in use, none validated against outcomes, and the diagnosed and criteria-positive populations overlap by only about a third — a measurement crisis that runs through every statistic in the field. Mechanism is genuinely unresolved and actively contested: amplified central pain processing, small-fiber pathology in a minority, a provocative-but-unreplicated antibody-transfer line, a newly mapped genetic architecture (26 loci, brain-enriched), and a disputed gut-microbiome contribution. Treatments help minorities modestly — exercise carries the strongest recommendation, three-to-four drugs are FDA-approved with NNTs of 5–11 while the EMA has approved none, and NICE advises against starting the very drug classes the FDA approved. The human dimension is inseparable from the science: fibromyalgia ranks last in physician disease-prestige surveys, and the average patient spends years being disbelieved before diagnosis.
Start here: overview.md → then a path below. The frontier lives in OPEN-QUESTIONS.md (open with its Dots not yet connected table). Growth history: LOG.md.
Reading paths¶
- Clinical path — overview → diagnostic criteria → guidelines → pharmacologic therapy → non-pharmacologic therapy → comorbidities & overlap → outcomes & measurement
- Science path — pathophysiology-central → pathophysiology-peripheral → autoimmunity & inflammation → genetics & risk factors → sleep, fatigue & cognition → omics & emerging science
- "What's unknown" path — OPEN-QUESTIONS.md → biomarkers → clinical trials landscape → the Open-questions section at the bottom of any page
- Human path — patient experience & advocacy → history & nosology → epidemiology → statistics sheet
Wiki pages¶
| Section | Page | One-line scope | Status |
|---|---|---|---|
| Foundations | overview.md | The condition, nociplastic framing, burden, map of this wiki | curated |
| Foundations | history-and-nosology.md | Fibrositis → FM; contested-illness history; taxon-vs-dimension debate | curated |
| Foundations | diagnostic-criteria.md | Criteria genealogy 1990→2019; agreement studies; sex-ratio artifacts | curated |
| Foundations | epidemiology.md | Prevalence by criteria set, delay, costs, disability, mortality/suicide | curated |
| Mechanism | pathophysiology-central.md | Central sensitization, imaging, CSF, glia — and the specificity problem | curated |
| Mechanism | pathophysiology-peripheral.md | Small-fiber pathology, silent nociceptors, the periphery-vs-center debate | curated |
| Mechanism | autoimmunity-and-inflammation.md | IgG transfer line, autoantibodies, cytokines — status of the hypothesis | curated |
| Risk & overlap | genetics-and-risk-factors.md | Heritability, the 2.5M-person GWAS, triggers with evidence grades | curated |
| Risk & overlap | sleep-fatigue-cognition.md | Alpha-delta history, prospective sleep→pain evidence, fibrofog numbers | curated |
| Risk & overlap | comorbidities-and-overlap.md | COPC framework, quantified overlaps, concomitant FM in arthritis | curated |
| Clinical | pharmacologic-therapy.md | NNT/NNH scoreboard, 2025 approval, failures & harms, FDA-vs-EMA split | curated |
| Clinical | non-pharmacologic-therapy.md | Exercise anchor, CBT/ACT, neuromodulation, digital ACT | curated |
| Clinical | guidelines.md | EULAR/Canadian/German/NICE synthesis and the transatlantic contradiction | curated |
| Clinical | outcomes-and-measurement.md | FIQR, responder definitions, placebo/nocebo mechanics, comparability | curated |
| Frontier | biomarkers.md | Classifier claims vs validation reality; the FM/a case; circularity problem | curated |
| Frontier | omics-and-emerging-science.md | GWAS, microbiome contest, metabolomics, ML, mechanism-to-target gap | curated |
| Frontier | clinical-trials-landscape.md | 70-trial NCT-verified map; design pathologies; the graveyard | curated |
| Human | red-flags-and-safety-concerns.md | Mimic red flags, re-evaluation triggers, medication safety, suicide-risk signal, exploitation risks | draft |
| Human | patient-experience-and-advocacy.md | Stigma & legitimacy evidence, diagnosis journey, organizations, priorities | curated |
Literature layer¶
| Artifact | What it holds |
|---|---|
| BIBLIOGRAPHY.md | Master bibliography: 392 unique papers, PMID-verified, tagged, cited-by-indexed |
| notes/ | 15 structured deep notes (ACR 1990, Gracely fMRI, Goebel IgG, Kerrebijn GWAS, EULAR 2017…) |
| guidelines/REGISTRY.md | 23 guideline/criteria documents + 5 regulatory decisions; 14 verified discordance points; watch list |
| statistics/STATISTICS.md | ~85 criteria-stratified figures; 9 documented statistical conflicts |
| patient-voice/ | 14 verified organizations, 10 experience themes, 73 annotated sources |
Curation state¶
18 of 19 pages are status: curated as of 2026-08-28: an independent five-agent audit re-verified every inline citation against live PubMed/ClinicalTrials.gov records — ~290 unique PMIDs and all 68-70 NCTs re-checked, ~700 claim-citation pairs examined, zero fabricated or wrong-paper citations, ~15 substantive precision/staleness errors found and fixed (the largest: a trial listed as pending that had reported negative in 2021; a dose narrative error; an unsupported conflict-of-interest claim reversed), and every flagged soft spot resolved or converted to a dated evidence-gap statement. The new red-flags page enters as draft pending its own audit pass. Details in LOG.md.