Fibromyalgia — master index¶
Last curated: 2026-10-30 · 19 wiki pages (15 curated, 4 draft) · 406 unique-PMID master bibliography · 15 landmark-paper notes · guidelines registry (27 documents + 5 regulatory decisions) · statistics sheet · 77 tracked trial IDs (76 re-checked in the 2026-10-30 sweep, 1 added) · 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 | draft |
| 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 | draft |
| 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 | draft |
| 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 | Trial map, including a published IgG-lowering RCT; design pathologies | draft |
| Human | red-flags-and-safety-concerns.md | Mimic red flags, re-evaluation triggers, medication safety, suicide-risk signal, exploitation risks | curated |
| Human | patient-experience-and-advocacy.md | Stigma & legitimacy evidence, diagnosis journey, organizations, priorities | curated |
Literature layer¶
| Artifact | What it holds |
|---|---|
| BIBLIOGRAPHY.md | Master bibliography: 406 unique PMIDs, tagged, cited-by-indexed |
| notes/ | 15 structured deep notes (ACR 1990, Gracely fMRI, Goebel IgG, Kerrebijn GWAS, EULAR 2017…) |
| guidelines/REGISTRY.md | 27 guideline/criteria documents + 5 regulatory decisions; 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¶
The 2026-08-28 independent audit promoted the original 18 pages after live record and claim checks. On 2026-10-09, autoimmunity, clinical trials, and guidelines were updated and demoted to draft pending an independent audit; on 2026-10-23 pharmacologic therapy joined them after a new 151-trial network meta-analysis was added. Fifteen pages remain curated; the red-flags page was independently audited on 2026-08-31. Details in LOG.md.
The 2026-10-30 sweep added four bibliography-only papers and one exploratory biomarker/neuromodulation registration, and sharpened OQ-5. The clinical-trials page remains draft; no other wiki page changed.