There are rheumatologists who might prefer the title of this editorial to be abbreviated to: “Should we manage fibromyalgia?” Or changed to “What is to be done about fibromyalgia?” When you attend regional, national, and even international meetings it seems that interest in fibromyalgia among rheumatologists is increasing, commensurate with a decline in enthusiasm for actually managing patients with the syndrome. Such has been the success of those who preached the gospel of fibromyalgia, who proselytised to the doubting Thomases over the past two decades, that to harbour, let alone express, reservations is regarded as heresy. I would not admit to having had a “road to Damascus” conversion to disbelief, but I do agree with others that a rethink is necessary.1-3 That the diagnosis has gained credibility cannot be doubted. Fibromyalgia is now a familiar concept and diagnosis among general practitioners, physiotherapists, general physicians, and even (heaven help us) some orthopaedic surgeons. Patients may request or demand a specialist consultation after self diagnosis, and often come clutching pages of information downloaded from the internet. The self help movement has an apparently unstoppable momentum, especially in North America. In fibromyalgia, we may have created a monster. Is it now clinically, socially, and financially appropriate to slay that monster?1

Even Dr Fred Wolfe, who has done so much quality research into fibromyalgia and published so prolifically, is entertaining second thoughts.2 These have arisen because in North America, and increasingly so in the United Kingdom, the concept of fibromyalgia is being highjacked by lawyers. Those who satisfy the 1990 ACR Classification criteria are being accepted as permanently disabled, and are receiving workers compensation, personal injury payouts, and early retirement pensions.3 ,4 These criteria were surely not designed to legitimise a purely subjective disorder of chronic pain and perceived …