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Curation log — fibromyalgia

Newest entries first. Every content-changing session appends an entry. See CLAUDE.md.

2026-10-30 — Periodic literature sweep (since 2026-10-23)

Author engine: Codex. Independent audit pending; no page promoted. Publication-date and entry-date windows are inclusive, 2026-10-23–2026-10-30. Only this condition was edited. No publishing or version-control commands were run.

Sources actually queried. Search manifest records exact queries, PubMed translations, returned identifiers, trial snapshots, source access and triage.

  • PubMed E-utilities esearch/efetch: broad fibromyalgia[tiab] AND 2026/10/23:2026/10/30[dp] (12), the same with [edat] (22), and MeSH FM with the combined date window (4). The twelve topic groups from the previous sweep were each searched with (2026/10/23:2026/10/30[dp] OR 2026/10/23:2026/10/30[edat]): criteria/epidemiology 15; central mechanism 7; peripheral 3; immune/inflammation 1; genetics/omics 1; sleep/fatigue/cognition 9; overlap 8; pharmacologic 8; non-pharmacologic 7; guidelines/safety 2; outcomes/biomarkers 8; patient experience 2. Also systematic reviews/meta-analyses (2), randomised trials (4), guideline/recommendation types (2), the undated FcRn follow-up (7), and the 2026 MAGIC/rapid-recommendation query (4). 23 distinct window records were title/abstract screened; older follow-up records are not counted as new. Additional Europe PMC PMIDs were fetched through E-utilities before preserving them in the manifest.
  • Cochrane through PubMed: "Cochrane Database Syst Rev"[jour] AND (fibromyalgia OR "chronic widespread pain"), with the same date window, both broad and crossed with each of the twelve topic groups: 0 records in every query. The broader chronic-pain/nociplastic CDSR query also returned 0. These are PubMed-indexed-CDSR findings. CENTRAL and the Cochrane Library were not searched (known HTTP 403).
  • Europe PMC REST: (fibromyalgia OR "fibromyalgia syndrome" OR "chronic widespread pain") AND FIRST_PDATE:[2026-10-23 TO 2026-10-30] (20 records, 8 without PMID), plus all twelve topic queries and the small-fibre preprint follow-up. No non-PMID record survived triage. The four retained papers' core records had no PMC full text; direct retrieval of the blood-pressure paper returned HTTP 403 and the pregnancy review's DOI destination served a JavaScript verification page. Bibliography entries therefore carry no new numerical or mechanistic result claims. The small-fibre review remains a preprint in the retrieved Europe PMC record; this is not a claim of exhaustive publication tracking.
  • ClinicalTrials.gov v2: all 76 previously cited IDs retrieved successfully. Status, last-update date, results-first-post date and results availability were unchanged for all 75 records with structured snapshots in the 2026-10-23 manifest; the additional extension-trial baseline was retrieved too. None of the 76 had an update posted in this sweep window. The separate condition query fibromyalgia with AREA[LastUpdatePostDate]RANGE[2026-10-23,2026-10-30] returned 11 records, none with posted results. This query, rather than the tracked list alone, found the new registration below.
  • Non-US registries: ISRCTN's public WHO-format XML API returned the first 100 matches for fibromyalgia; this was a bounded search, not an exhaustive change audit (the larger/internal-format request failed HTTP 400). The EU Clinical Trials Register's fibromyalgia query listed 75 results, and all four listing pages were retrieved; this is the legacy register, not CTIS. The direct UK FcRn record URL returned a generic register page, so it supplies no independently verified trial update. Brazil's ReBEC RBR-6prps8g record was retrieved for the new HOTFy economic paper; its last approval is from 2022 and its recruitment label is stale relative to the paper, so no current-status inference was made. WHO ICTRP portal HTML was retrieved but yielded no usable study results; it is not counted as searched.
  • Guidelines: live EULAR management catalogue, NICE NG193 overview, BMJ Rapid Recommendations search-result content, plus the PubMed guideline searches above. No new FM-specific replacement was identified in those sources. AWMF 145-004's current register page was bot-blocked; search results served expired 2017 documents, which cannot establish the current revision state. The AAN/AHS and Goebel follow-ups were rechecked in Europe PMC; their full texts were not retrieved, so the previous recommendation/supplement follow-ups remain open.
  • Burden and patient organisations: targeted web searches for FM prevalence/burden/registry updates and October organisation material; live FMA UK homepage, NFA homepage and fibromyalgia-news page, ENFA homepage and news page. No new dated material was retained. ENFA's October-15 webinar notice lacked a verifiable year in the retrieved text and was not treated as a new 2026 item. NFMCPA returned HTTP 403. No new burden estimate met the source-verification threshold for the statistics sheet.

Access limits. SciELO and LILACS could not be searched (HTTP 403 per SOURCES.md; not re-probed); no inference about absence of regional evidence is made. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL is unset. Crossref was queried without a contact address. No CENTRAL, CTIS, subscription-database or operable WHO-ICTRP search is implied.

Triage and changes. Four papers were added only to the bibliography, with full text explicitly not retrieved: Pereira's pregnancy/postpartum systematic review (PMID 42924382); Morales's FIT-Teens secondary analysis (PMID 42925908); Parisien's cross-condition blood-transcriptomics study (PMID 42926172); and Magen's matched blood-pressure/recorded-diagnosis study (PMID 42930870). The other 19 window records were omitted or deferred: mostly narrative/conceptual reviews, adjacent-disease mentions, small exploratory studies or case series. The Brazilian hyperbaric-oxygen economic evaluation (PMID 42914549) needs its full model and tables before its cost-effectiveness estimates can be used; its registry was checked rather than inferring from ClinicalTrials.gov.

NCT07904351 was added to wiki/clinical-trials-landscape.md and the bibliography: MGH VagaCalm active-versus-sham auricular stimulation, participant/investigator masked, estimated n=105, not yet recruiting, first posted 2026-10-29, no results. The registration describes exploratory stool intestinal alkaline phosphatase (IAP) measurements; it does not select participants by IAP. Week-six pain is the primary outcome; the narrative's six-week treatment and roughly eight-week follow-up were distinguished from its eight-week design-field description. OQ-5 now asks specifically for baseline biomarker-by-treatment interaction and external validation, rather than treating symptom association as treatment selection. This is a prospective follow-up, not an answered question or a validated biomarker.

last-curated on the trial page and the existing “Last curated” lines in the bibliography, open questions and index were updated. The trial page remains draft. INDEX.md now reports 406 unique bibliography PMIDs (the pre-sweep file actually had 402, despite the stale index count of 399) and 77 tracked trial IDs. REGISTRY.md, STATISTICS.md, other wiki pages and the patient-voice layer were left unchanged because no source-verified change survived triage for them. No deep note was warranted.

Retraction checks. All four added journal records were fetched through live PubMed E-utilities; none carried Retracted Publication or Expression of Concern. Each DOI resolved to its matching title through Crossref, with empty updated-by: 10.61622/rbgo/2026rbgo49; 10.1016/j.jpain.2026.106475; 10.1016/j.bja.2026.08.040; 10.3390/jcdd13100474. These checks establish the retrieved metadata state, not a guarantee against later notices.

Validation. Added-line PMID and trial-identifier provenance, all four dual retraction checks, the draft/date fields, bibliography/trial counts and new local links passed. The production site path planner maps the manifest to sweeps/2026-10-30.json, and its LOG-link transformation was checked. No full site build, frontend regeneration or publishing was run; the work remains limited to this condition. This technical verification is not an independent content audit.

Next sweep. Retain both tracked-ID and condition-level trial queries. Follow the VagaCalm protocol/statistical analysis plan and whether baseline IAP is tested as a treatment-effect modifier. Seek full texts for the four bibliography additions, particularly the transcriptomics cohort definitions and blood-pressure measurement-opportunity analyses; do not infer disease-onset prediction from precedence over recorded diagnosis. Read the HOTFy economic model and tables before adopting its estimates. Continue the BMJ/MAGIC guideline, current AWMF revision, AAN/AHS FM recommendation, FcRn supplement, small-fibre preprint and FDA AFFIRM/RALLY follow-ups. The four pre-existing draft wiki pages still await a different engine's independent audit.

2026-10-23 — Periodic literature sweep (since 2026-10-09)

Author engine: Claude (Opus 5.5). Not self-audited — the pages changed below await an independent audit by a different engine.

Sources and searches actually run. PubMed E-utilities: broad fibromyalgia[tiab] AND 2026/10/09:2026/10/23[dp] (23) and the same with [edat] (43); fibromyalgia[mh] in the window (11); the twelve topic-term groups used on 2026-10-09, each as fibromyalgia[tiab] AND (<terms>) AND (<window>[dp] OR <window>[edat]) (criteria/epidemiology 30, central 16, peripheral 4, immune 8, genetics/omics 3, sleep/fatigue/cognition 22, overlap 11, pharmacologic 17, non-pharmacologic 21, guidelines/safety 14, outcomes/biomarkers 28, patient experience 4); systematic reviews/meta-analyses (7); RCTs (11); guideline publication types (4); and an undated FcRn query (rozanolixizumab OR FcRn OR efgartigimod OR nipocalimab × FM/chronic pain; 7, none new for FM). Union: 45 window records, all title-screened. Cochrane: "Cochrane Database Syst Rev"[jour] AND (fibromyalgia OR "chronic widespread pain") and ... AND ("chronic pain" OR nociplastic OR "chronic primary pain"), both in the window — 0 PubMed records each. This is a PubMed-indexed-CDSR finding; CENTRAL was not searched (cochranelibrary.com HTTP 403). Europe PMC REST (fibromyalgia OR "fibromyalgia syndrome") AND FIRST_PDATE:[2026-10-09 TO 2026-10-23]: 68 hits, 39 without PMID (preprints and PMC-only records; none survived triage), plus targeted queries for the tracked small-fibre meta-analysis preprint and FcRn follow-ups. ClinicalTrials.gov v2: all 75 previously cited NCT IDs re-queried — no record had a last-update post on or after 2026-10-01 and none newly posted results; plus a condition search for FM records updated since 2026-10-09 (24 records), which found one relevant trial not tracked before (below). Crossref updated-by checked for all six new DOIs. Full text read via Europe PMC for the BMJ Med network meta-analysis (PMC13647175); the J Rheumatol opioid paper's PMC full text was not served (abstract only). Search manifest: literature/sweeps/2026-10-23.json.

Not searched or not reachable: WHO ICTRP (not programmatically operable, so not counted); SciELO/LILACS (not attempted; HTTP 403 per SOURCES.md); no regional-absence claim is made. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL is unset; Crossref was queried without mailto.

Society/guideline checks: PubMed guideline queries (above) and a targeted fibromyalgia AND ("rapid recommendation" OR MAGIC OR "clinical practice guideline") AND 2026[dp]. Patient organisations: the FMA UK homepage and NFA (fmaware.org) homepage had nothing dated September–October 2026; the FMA UK news URL returned 404, and NFMCPA (fmcpaware.org) returned HTTP 403 again. No patient-voice change.

Retraction checks. PubMed publication types for all seven added PMIDs show no Retracted Publication or Expression of Concern. Crossref updated-by is empty for all six DOIs checked: 10.1136/bmjmed-2026-002902, 10.3899/jrheum.2026-0220, 10.1016/j.jpain.2026.106469, 10.1213/ANE.0000000000008327, 10.3389/fpain.2026.1911020 and 10.3899/jrheum.2025-1375. The AAN guideline DOI was not run through Crossref; its PubMed type is Practice Guideline.

What survived triage and changed. - Zeraatkar 2026, BMJ Med (PMID 42851751): the most important find. It is the largest FM-specific drug network meta-analysis (McMaster/MAGIC, part of the BMJ Rapid Recommendations project; 151 RCTs, 32,592 participants; GRADE). Its findings were checked as verbatim passages in the full text: no drug's pooled effect on pain, physical health or mental health reached the minimal important difference; ≥30% pain-relief responder gains ranged from 111/1,000 (SNRIs) to 202/1,000 (sodium oxybate), with 75/1,000 for gabapentinoids; naltrexone likely had little or no effect (moderate certainty); the cyclobenzaprine evidence came from the sublingual patent holder without independent replication; and only 9 of 151 trials ran beyond six months. It contradicts nothing the wiki asserts. It reinforces the existing "small and not clinically relevant" verdict and supplies a GRADE responder-versus-average framing. Added to wiki/pharmacologic-therapy.md (body paragraph and ref 49), which moved from curated to draft because a model may not audit its own edit. Also added to STATISTICS §5.1, sharpened OQ-23 (follow-up length) and OQ-24 (a forthcoming MAGIC/BMJ guideline), and added a watch-list row to the guidelines registry. No landmark note was written. It is a candidate if the resulting guideline cites it as its evidence base. The authors' statement that AFFIRM and RALLY "were subsequently excluded from the FDA submission" was not added; it should be verified against FDA review documents first. - NCT07637162 (AXS-14-FM-302): a Phase 3 open-label 52-week safety extension of esreboxetine (n=300 est., enrolling by invitation, started 2026-04-29, first posted 2026-06-09). Earlier tracked-ID sweeps missed it. Added to wiki/clinical-trials-landscape.md §3 and its trials-cited list (page was already draft; last-curated bumped), and to the bibliography. - Anastasiou 2026, J Rheumatol (PMID 42880888): in 45,455 Medicare-enrolled adults aged ≥65 with rheumatic disease, FM was independently associated with chronic opioid use (aOR 2.68, 95% CI 2.39–3.00). Added to STATISTICS §5.3 from the abstract only. It partly answers the 2026-08-28 follow-up asking for a primary claims source on opioid use, but for older Medicare patients only and without an FM-specific prevalence. - AAN/AHS 2026 migraine-prevention guideline (PMIDs: 42673560, 42673606): registered as adjacent guideline #27, because its abstract says the recommendations address patients with fibromyalgia. The recommendation text was not retrieved (Neurology HTTP 403; no Europe PMC full text), so wiki/guidelines.md was not edited. - Bibliography-only lines: Kim 2026 (UK Biobank, three latent FM subgroups, PMID 42869356); Woodbury 2026 (cranial electrotherapy stimulation sham-controlled feasibility RCT in which pain improved equally in both arms, PMID 42868517); Ajay 2026 (MICRO-FMS microneurography protocol, PMID 42898500); Ancona 2026 (DGBI in juvenile FM, 76% of 63 patients, PMID 42744395). - INDEX.md counts and statuses updated. The table row for red-flags said draft, but the page's frontmatter has said curated since the 2026-08-31 audit; the row was corrected to match. - Triaged out: the other 38 window records. They were off-topic (other diseases that mention FM), animal reserpine models, single-centre cross-sectional studies, small exercise RCTs (e.g., PMIDs 42850493, 42867081, 42863823, which add nothing beyond the exercise evidence already cited), narrative reviews, or preprints. One preprint is worth watching rather than citing: TSPO binding-affinity genotypes in FM/ME-CFS/MS (medRxiv doi:10.64898/2026.10.19.26365953).

Next sweep. Have a different engine audit the four draft pages (autoimmunity, clinical trials, guidelines, pharmacologic therapy). Watch for the MAGIC/BMJ Rapid Recommendation FM guideline and register it when it appears. Retrieve the AAN/AHS guideline's FM recommendation text before describing it. Verify the claim that AFFIRM and RALLY were excluded from the FDA submission against FDA documents. Track MICRO-FMS results. The small-fibre meta-analysis preprint (doi:10.64898/2026.09.05.26362344) is still unpublished in peer review per Europe PMC, so keep following it. Goebel 2026 still has no open full text (Europe PMC: not OA, not in EPMC), so the 2026-10-09 follow-ups on its supplement stand. Open questions to settle: why the condition-level ClinicalTrials.gov search surfaced NCT07637162 when tracked-ID checks could not; whether a routine "new FM records since last sweep" CT.gov query should be standard (it was run this time); and whether an AWMF 145-004 update has appeared (not rechecked this sweep).

2026-10-09 — Periodic literature sweep (since 2026-08-31)

Sources and searches actually run. PubMed E-utilities esearch/efetch: broad fibromyalgia[tiab] AND 2026/08/31:2026/10/09[dp] (132 records, including online-first items with later print dates) and fibromyalgia[tiab] AND 2026/08/31:2026/10/09[edat] (97 records). Twelve topic searches used fibromyalgia[tiab] AND (<topic terms>) AND 2026/08/31:2026/10/09[dp]: criteria/epidemiology (85), central mechanism (51), peripheral mechanism (16), immune/inflammation (17), genetics/omics (9), sleep/fatigue/cognition (53), overlap/comorbidity (41), pharmacologic therapy (32), non-pharmacologic therapy (36), guidelines/safety (27), outcomes/biomarkers (60), patient experience (9). The terms were, respectively: diagnos* OR criteria OR prevalence OR incidence OR burden OR epidemiolog*; central sensitization OR neuroimag* OR brain OR glia OR nociplastic; small fiber OR small fibre OR peripheral OR nociceptor*; autoimmun* OR antibody OR inflammation OR cytokine*; genetic* OR GWAS OR microbiom* OR metabolom* OR omics; sleep OR fatigue OR cognition OR cognitive; comorbid* OR overlap OR migraine OR irritable bowel OR ME/CFS; drug OR pharmacolog* OR duloxetine OR pregabalin OR cyclobenzaprine OR naltrexone OR cannabinoid*; exercise OR physical therapy OR cognitive behavioral OR CBT OR ACT OR acupuncture OR neuromodulation; guideline OR consensus OR safety OR adverse OR opioid OR suicid*; outcome* OR FIQR OR FIQ OR biomarker* OR classifier; patient experience OR stigma OR qualitative OR advocacy. PubMed translations were inspected. The exact broad Cochrane query "Cochrane Database Syst Rev"[jour] AND (fibromyalgia OR "chronic widespread pain") AND 2026/08/31:2026/10/09[dp] returned 0 PubMed records; the same journal/condition/date restriction with each of the 12 topic-term groups also returned 0. This is a PubMed-indexed-CDSR finding, not a CENTRAL search.

Europe PMC REST /search was queried with (fibromyalgia OR "fibromyalgia syndrome") AND FIRST_PDATE:[2026-08-31 TO 2026-10-09] and the same 12 topic groups: 328 broad records, 72 without PMID (predominantly preprints and meeting material). Europe PMC full-text flags showed no repository full text for the two papers added this sweep. ClinicalTrials.gov v2 /api/v2/studies/{id} was queried for all 74 previously cited NCT IDs plus NCT05643794. Three tracked recruiting records had September update-post dates (NCT06009159, NCT07186751, NCT07398417); their current statuses remained recruiting and none posted results. NCT05643794 was completed with posted primary-outcome and adverse-event results in 2025, but the prior intervention-term search had missed it. For this UK trial, the UK Health Research Authority summary was checked as a non-US trial source; it links the study to EudraCT 2022-001523-32. The EudraCT registry URL for 2022-001523-32 was queried directly but returned a generic register page without trial data; the HRA record supplies the independent UK registration check. The WHO ICTRP portal was opened, but its search could not be operated programmatically, so it was not counted as searched. UCB's full 16-page plain-language study-results PDF and the ClinicalTrials.gov posted outcome table were read. The journal full text was subscription-only per Europe PMC; the paper's abstract, registry results and sponsor summary support the limited statements added here.

Society/guideline checks: EULAR management recommendations, AWMF register 145-004, NICE NG193 recommendations, and targeted PubMed/society-site searches. No newer FM-specific EULAR, AWMF or NICE replacement was located in those checked sources. The Italian SIMFER chronic-primary-pain physical-modality guideline was found retrospectively (June 2026 publication, PMID 42262745). Burden/registry check: the October-print Israeli administrative cohort (PMID 42551405) was already in this condition's bibliography and epidemiology page; its Europe PMC record provides no open full text, so no new numerical burden claim was added. Patient-organisation checks covered FMA UK, NFA, Fibromyalgia National Health Organization, ENFA and Norwegian association search listings; no new material merited the patient-voice layer. A potentially relevant Fibromyalgia National Health Organization diagnostic-bias page returned HTTP 403 on direct fetch, so it was not cited. SciELO search returned HTTP 403 and the LILACS/BVS portal timed out; no claim about absence of Latin American regional literature is made. Cochrane Library/CENTRAL was not searched. Unpaywall was skipped (no approved contact address used).

Retraction/provenance checks. PubMed publication types for the two added journal records (PMIDs 42748952 and 42262745) showed neither retraction nor expression of concern; both DOIs resolved through Crossref with matching titles and empty updated-by fields. A candidate patient-experience record (PMID 41588867) had a Crossref DOI/title mismatch and was quarantined rather than cited.

What survived triage and changed. The phase 2A randomized FcRn-blockade/IgG-lowering trial (Goebel 2026, PMID 42748952; NCT05643794) enrolled 63 people with severe FM. Its ClinicalTrials.gov primary-outcome table reports a 12-week BPI-SF interference difference of −0.54 (95% CI −1.24 to 0.16; two-sided p=0.129). The paper reports that the prespecified one-sided 10% exploratory threshold was met (p=0.065) but concludes there was no meaningful group-level benefit. It did not select by a pathogenic-antibody assay. This overturns the old claim that no controlled IgG-lowering FM trial exists, not the separate question of a biomarker-defined subgroup. Updated wiki/autoimmunity-and-inflammation.md, wiki/clinical-trials-landscape.md, the Goebel 2021 landmark note, OPEN-QUESTIONS.md (D3 and OQ-3), literature/statistics/STATISTICS.md, and literature/BIBLIOGRAPHY.md. Added SIMFER to literature/guidelines/REGISTRY.md, the bibliography and wiki/guidelines.md. The 2026-08-31 log follow-up led to correcting NICE's wording to do not initiate and removing two overly uniform opioid-guideline claims in the guidelines/statistics layers. Updated INDEX.md counts/statuses. The three edited wiki pages and the edited landmark note are draft; no new deep note was created because the journal trial full text was unavailable. No patient-voice page changed.

Next sweep. Seek the complete Goebel 2026 paper and supplement to examine IgG pharmacodynamics, secondary endpoints, multiplicity and subgroup analyses before any stronger mechanistic inference; independently audit the three draft wiki pages and note. Check for a biomarker-stratified FcRn or other IgG-lowering trial through ClinicalTrials.gov plus UK/EU registries, and revisit AWMF's overdue revision and the full SIMFER guideline. Follow the non-PMID small-fibre meta-analysis preprint in Europe PMC for peer-reviewed publication; retry the blocked patient-organisation article only if it becomes fetchable. Recheck the quarantined DOI/title mismatch before use.

2026-08-31 — Audit pass: red-flags-and-safety-concerns.md → curated

Scope: the one remaining draft page in this condition. No other FM page touched.

Searches run. PubMed esummary + efetch for all 41 unique PMIDs on the page; full text via PMC for the 2012 Canadian guideline (PMC3673928) and Häuser & Fitzcharles 2018 (PMC6016048); targeted PubMed searches for a triptan/SSRI-SNRI serotonin-syndrome source, for the German AWMF diagnostic guideline, and for any guaifenesin FM trial; direct retrieval of NICE NG193 recommendations.

Result: 41/41 records exist and match their reference-list entries; 0 fabricated or wrong-paper citations. Numeric claims checked against source abstracts and re-read in context where direction mattered (Wolfe κ values, Treister-Goltzman SMRs, Adawi ideation/attempt estimates, Duffield score inflation, Derry NNH, Fitzcharles opioid prevalence, Gore claims figures, Wall CAM percentages, Shaver polypharmacy). All correct. Two apparent misses were source-side typos, not page errors: Bennett's title says 2,596 where its abstract says 2,569 respondents, and the abstract spells alprazolam "aprazolam".

Errors found and fixed. - Canadian guideline overstated. The page said it "permits only tramadol among opioids". Its actual recommendations, read from the full text: rec 29 — a trial of opioids beginning with a weak opioid such as tramadol, reserved for moderate-to-severe pain unresponsive to other modalities (level 2, grade D); rec 30 — strong opioid use is discouraged, with continued users required to show improved pain and function. Rewritten verbatim-accurate. This also softened the TL;DR's "near-universal guideline recommendations against", which flattened a real spread between Canada 2012, EULAR 2017 and NICE. - NICE claim was unverifiable from its cited record (Carville 2021 has no PubMed abstract) and slightly wrong in verb. NG193 rec 1.2.10 says do not initiate opioids — alongside gabapentinoids/antiepileptics, antipsychotics, benzodiazepines, NSAIDs and paracetamol — for chronic primary pain in people 16+, and governs initiation rather than existing users. Now cited to NICE directly per CONVENTIONS §1 non-journal format. (Supersedes the standing follow-up "NICE NG193 full text 403/CAPTCHA-blocked" — it is retrievable.) - Mis-attribution: "pregabalin is preferred by misusers over gabapentin" was credited to Evoy 2021; that finding is Bonnet & Scherbaum's (users cite faster, stronger euphoria than oral gabapentin). Moved, and Bonnet's more informative numbers added (14 studies + 38 case reports; only 4 individuals met behavioural dependence criteria without another SUD, all on pregabalin). - Over-precision: Derry's NNH 3.7/7.4 are "for all doses combined", not "at 300–600 mg". Corrected, and the 70–90% adverse-event figure clarified as applying to all arms including placebo — which is the point of quoting it. - Orphan reference used: Macfarlane 2017 (EULAR, PMID 27377815) was in the reference list but cited nowhere. Now carries its own verified claim — every pharmacological option 'weak for', exercise the only 'strong for'.

Three of the five [unverified] markers resolved; two rewritten as explicit evidence gaps. - SNRI/triptan serotonin syndrome — resolved and now the strongest passage in the section. The FDA's July 2006 alert rested on 29 case reports; obtained under FOIA and scored, 7 met Sternbach criteria, none met Hunter criteria, and Evans concluded the data do not support prohibiting the combination (PMID 18092054). The 2010 AHS position paper classed it Level U; co-prescribing rose 90.1% between 2003–04 and 2007–08 to 1.8% of the relevant population with the resulting case count still undocumented (PMID 22289074). This converges with the page's existing Ryan & Isbister finding — signal strong in spontaneous reports, thin in criteria-confirmed events. - German AWMF checklist — the guideline itself is now cited (Eich 2017, PMID 28421273: AWMF 145/004, 13 societies + 2 patient organisations, diagnosis by ACR 1990 or modified ACR 2010/2011); its item-level red-flag list is not in the indexed record, stated as such. - Guaifenesin trial — searched; PubMed returns three guaifenesin+FM records, none a trial. Named as an absence rather than flagged. - Benzodiazepine harm data in FM and re-evaluation protocols — genuinely absent, not unverified. Rewritten as evidence-gap statements ("this is an evidence gap, not a safety clearance") and the [unverified] markers removed, since the markers implied doubt about a cited claim when the claim is the absence itself.

Frontmatter: status: draft → curated, last-curated: 2026-08-31. Reference list grew 41 → 45 (Eich, Evans, Sclar, NICE NG193).

Follow-ups. Reference 45 is this repository's first non-journal citation on an FM page — check guidelines uses the same NG193 wording ("do not initiate", 16+, initiation vs. continuation), since that page also summarises NICE. The Canadian-guideline correction may propagate: any other page saying FM guidelines uniformly recommend against opioids should be re-read against rec 29/30.

2026-08-28 — Initial build + audit pass

  • Scaffolded the condition per the add-a-new-condition workflow; canonical 18-page list added to CONVENTIONS §5 (designed for FM's shape: criteria genealogy, contested nosology, central/peripheral/autoimmune mechanism split, outcomes-and-measurement as first-class page).
  • Built all 18 wiki pages via eight domain research passes (foundations, mechanism, risk/sleep/overlap, clinical, frontier, patient voice, guidelines registry, statistics), each grounded in live PubMed/ClinicalTrials.gov/web queries.
  • Literature layer: BIBLIOGRAPHY.md (355 unique PMIDs, six sections, fragments merged and removed after parity check); 15 landmark notes; guidelines registry (23 documents + 5 regulatory decisions, 14 verified discordances); statistics sheet (~85 criteria-stratified figures, 9 documented conflicts); patient-voice layer (14 orgs verified by fetch, 10 themes, 73 annotated sources).
  • OPEN-QUESTIONS.md: 29 questions (9 Tier-1) + 12-junction "Dots not yet connected" table.
  • Audit pass (complete): first launch of five auditors was terminated mid-run by an account session limit; relaunched same-day (protocol is idempotent). Results: ~290 unique PMIDs and all 68-70 NCTs re-verified; ~700 claim-citation pairs checked; 0 fabricated/wrong-paper citations; ~15 substantive errors fixed — biggest: IVIG-in-SFN trial (NCT02637700) listed as pending had reported negative in Neurology 2021 (PMID 33766992, propagated through the autoimmunity argument); TNX-102 SL dose narrative corrected (RELIEF/RESILIENT used identical titration; RALLY was the 5.6mg-throughout trial); an unsupported FM/a conflict-of-interest claim reversed (paper declares no competing interests); AAPT criteria conjunction corrected (sleep OR fatigue); NICE-vs-FDA contradiction narrowed to pregabalin only; Kerrebijn GWAS cohort characterization corrected from full text (uniform ICD-code definition). Soft spots resolved: Tonmya approval date (Aug 2025, PMID 42479282), Stanza FDA clearance (PMID 40469887), NICE acupuncture (PMID 33824137), sodium oxybate rationale (PMIDs 21679091, 23373093), Bennett 2003 tramadol RCT (PMID 12753877), ICD-11 code MG30.01 (PMID 36427885), miRNA absence claim overturned with 4 sourced studies. All 18 built pages promoted to curated. Two false "no such guideline" negatives overturned → registry now 25 documents (added Yokota 2013 juvenile Japan, PMID 23758613; Zhang 2025 China patient-version, PMID 41410191). Statistics sheet sampled ~50 sources/120+ figures: 0 numeric errors.
  • Red-flags page added (wiki/red-flags-and-safety-concerns.md, draft, 41 refs — mimic red flags, medication safety, suicide-risk signal, exploitation risks); bibliography grew to 392 unique PMIDs (audit additions + red-flags merge); needs its own audit pass next session.
  • Trials safety enrichment: in progress (stage primer + per-trial safety numbers, mirroring the TAA page).

Notable build-time finds: Kerrebijn 2026 Nat Med GWAS (2.5M individuals, 26 loci, brain-exclusive heritability — PMID 42521817); the 2025 FDA approval of sublingual cyclobenzaprine verified via PubMed-indexed sources; the microbiome causal-chain-vs-null contest (PMID 40280127 vs 42550534); Brazilian SBR Jan-2026 guideline (newest in the field); the diagnosed-vs-criteria-positive κ≈0.3 divide as the field's measurement crisis.

Follow-ups for next session(s): - Append audit results; promote clean pages; update INDEX statuses and curation-state paragraph. - Unresolved build-time items to keep chasing: AAPT core-criteria exact wording (no PMC for PMID 30453109); ICD-11 FM code; EMA CHMP rationale documents (not PubMed-indexed); Stanza FDA-authorization status; NICE NG193 full text (403/CAPTCHA-blocked); AWMF post-2017 revision existence; sodium oxybate FDA advisory record; JCFI Japanese guideline (web-verified only); Queiroz 2013 "2.7% global prevalence" (not in abstract — full-text pull); FM-in-SLE meta-analysis (none found); FM-migraine meta-analysis (none found); population FIQ/FIQR norms (none found); primary claims source for opioid-prescription rates. - Patient-voice coverage gaps: Africa/South Asia orgs (Facebook-only), several org sites blocked (NFMCPA 403, FCSA JS-only, Dutch F.E.S. TLS) — retry. - Add FM to the weekly sweep task and republish frontends after audit integration.