MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Fibromyalgia (FM) is one of the most frequent generalized pain disorders. It accounts for a sizable proportion of healthcare costs. Despite extensive research, the etiology (the ‘root cause’) of FM remains unknown – except, of course, to SCAM practitioners!

Most types of SCAM are said to be effective for FM (while the evidence for such claims is less than solid).

And almost every one of them claims to treat the ‘root cause’ of the condition. Which must mean that they are able to tackle its etiology, usually some disturbance of the ‘vital force’ or ‘energy’ flow. To patients, this sadly sounds impressive.

But what, if the etiology of FM is something entirely different?

New research shows that most (if not all) patients with FM belong to a distinct population that can be segregated from a control group by their glycated haemoglobin A1c (HbA1c) levels, a surrogate marker of insulin resistance (IR). This was demonstrated by analysing the data after introducing an age stratification correction into a linear regression model. This strategy showed highly significant differences between FM patients and control subjects (p < 0.0001 and p = 0.0002, for two separate control populations, respectively).

A subgroup of FM patients meeting criteria for pre-diabetes or diabetes (patients with HbA1c values of 5.7% or greater) who had undergone treatment with metformin showed dramatic improvements of their widespread myofascial pain. This was shown comparing pre and post-treatment numerical pain rating scale (NPRS). Response to metformin plus standard treatment (ST) was followed by complete resolution of the pain (report of 0 of 10 in the NPRS) in 8 of 16 patients who had been treated with metformin (50%), a degree of improvement never observed before in such a large proportion of FM patients subjected to any available treatment. In contrast, patients treated with ST alone improved, but complete resolution of pain was generally not observed. Interestingly, some patients responded only to metformin and not to ST with NSRIs or membrane stabilizing agents. Importantly, there was a long-term retention of the analgesic effect of metformin.

The authors concluded that these findings suggest a pathogenetic relationship between FM and IR, which may lead to a radical paradigm shift in the management of this disorder.

From my perspective, these findings also suggest that all the many SCAMs allegedly claiming to tackle the ‘root cause’ of FM have been barking up the wrong tree. In fact, all these claims of SCAM practitioners about treating the ‘root causes’ can easily be disclosed as a simple (and sadly effective) marketing gimmick. Six years ago, I even challenged the world of SCAM to name a single treatment that treats the ‘root cause’ of any disease. As yet, nobody has come forward with a convincing suggestion.

19 Responses to Fibromyalgia – can any type of SCAM treat the ‘root cause’ of this (or any other) condition?

  • When you write about conventional medicine that you are an expert in then what you write is top quality.

    Could you please try to do the same for your reviews of ‘homeopathy’?

    Thank you.

    • so you did not notice that this post was as much about homeopathy as anything else?

      • It is about the ‘root cause’ of fibromyalgia.

        The SCAM critique component: please explain how it is about homeopathy.

        Thank you

        • can I suggest you read the post again and ask yourself in what way it might apply to homeopathy.

          • I have told you so many times already, it DOES NOT APPLY to homeopathy.

            Please let us know how you THINK it applies and then your ‘homeopathy’ misunderstanding will be completely clear.

            Thank you.

          • you have me in stiches!
            now you tell me what my own posts are about.
            BRILLIANT!

  • Right…if this was an alt med paper I suspect you would have ripped it to shreds.

    “We identified 23 patients from a retrospective chart review who were referrals to a subspecialty pain medicine clinic for the treatment of widespread myofascial pain.”

    “In our sample of patients, metformin was added to “standard treatment” for widespread myofascial pain.”

    “Response to metformin plus ST was followed by complete resolution of the pain (report of 0 of 10 in the NPRS) in 8 of 16 patients who had been treated with metformin (50%),…”

    • I did not even say a single word about the scientific rigor of the paper. why? because the authors are very clear that their findings are preliminary and they interpret them with great caution. their point was to report a novel finding that need confirmation and might impact on clinical care.
      this is entirely different from the papers that I ‘rip to shreds’; these are usually trials of treatments reporting an effect that is likely to be false positive because of numerous flaws.
      see the difference?

      • Well, if this is the best you can come up with on the topic of causation, sobeit.

        • so we were talking about causation, were we?

          • EE…so we were talking about causation, were we?

            Yes, you brought up causation…”And almost every one of them claims to treat the ‘root cause’ of the condition.”

            Then you brought in a low level study which doesn’t really even address the cause of FM.

            But like i said, perhaps this is the best you can do.

          • the best you can do is to not understand my post?

          • EE…”But what, if the etiology of FM is something entirely different?”

            You used a low level paper that doesn’t even address the etiology of FM.

            So yes, I understand.

            BTW, they have been looking at IR in FM suffers for years.

          • do you know the meaning of the word ‘if’?
            seems not!

      • I have looked at the paper and I’m a bit worried about the methodology used. It seems to be a (sort of) retrospective case-control study. These are always open to bias and so shouldn’t be used for anything other than generating hypotheses for rigorous testing (in all fairness that is more-or-less what the authors of the paper said).

        The 23 patients in the study were compared with historical controls from two different groups which had been studied elsewhere. I am not sure that there is any reason to suppose that they were comparable populations. Certainly it seems very unsound to compare the HbA1c levels found in different studies as the labs reporting the tests may well have used different methods for obtaining their results and different conventions for reporting them (in clinical practice it is unwise to assume that two labs are interchangeable and in clinical trials even more so). This alone could account for the differences found (at a level of p<0.0001 etc.).

        As far as I can gather from reading the paper, all 23 patients were given metformin and all reported improvement in their pain. As we know, there are many possible explanations for this.

        Nevertheless, they have some interesting ideas, which should be investigated in a proper controlled trial.

        I would like to make the observation that the standard therapies they used (amitriptyline, gabapentin, pregabalin etc.) are all more toxic than metformin, which is finding an increasing role in early type 2 diabetes, insulin resistence, and is being investigated as treatment for prostate cancer.

  • Edzard firing blanks again? When last did you use your Gunpowder suppositories?

    Your paper topic: Fibromyalgia (FM) is one of the most frequent generalized pain disorders. It accounts for a sizable proportion of healthcare costs. Despite extensive research, the etiology (the ‘root cause’) of FM remains unknown – except, of course, to SCAM practitioners!

    Your conclusion: ‘From my perspective, these findings also suggest that all the many SCAMs allegedly claiming to tackle the ‘root cause’ of FM have been barking up the wrong tree. In fact, all these claims of SCAM practitioners about treating the ‘root causes’ can easily be disclosed as a simple (and sadly effective) marketing gimmick. Six years ago, I even challenged the world of SCAM to name a single treatment that treats the ‘root cause’ of any disease. As yet, nobody has come forward with a convincing suggestion.’

    So, I ask you again: how does this relate to ‘homeopathy’, your pet SCAM modality?

    • perhaps you missed the title of my post; it’s the bit that defines its topic – and it’s certainly not you who does that.

  • Greg & DC,

    Are you arguing for the sake of argument or is there a punchline to your posts (i.e. the root cause of FM is X, therefore I/we propose the administration of Y in order to treat X)?

    If you can offer a substantiated opinion in this regard, I (and I imagine EE and others) are all ears/eyes.

    Better to be a “learn it all” than a “know it all”, friends.

  • The evidence of an organic etiology at the molecular level, even to be confirmed, is something infinitely superior to metaphysical lucubrations or clear products of fantasy.
    Arguing with intellectually dishonest people in the face of belonging to an underworld of medical knowledge is an utterly unproductive task. Pseudoscientific or non-scientific fundamentalism.

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