--is that patients are presenting to doctors with a pain syndrome that does not have any specific, detectable trigger or etiology--no injury, no demonstrable nerve damage, no obvious arthritic inflammation--and so doctors, being "show me" people, are at somwheat of a loss as to how to diagnose it.

Since they have "heard", or been told by patients, that many of these pains seem to be primarily muscular or joint located (that's the trigger point theory), they group them into the large category of "fibromyalgia"--literally, pain of the muscle fibers--and that's the diagnosis they are given. This is often done for the sake of convenience (and often, insurance reimbursement), to give people a handle on and a conceptual framework for their symptoms.

Now, I don't know if fibromyalgia is the most appropriate name for this condition--if, indeed, it is one condition. Something real IS occurring to these people--they're not faking or malingereing--but I suspect it's not always the same thing--or even, often, very similar things.

The fibromyalgia controversy has echoes of the chronic fatigue syndrome controversy of a few years back--indeed, it may have even replaced that one as a syndrome of mostly young, middle-aged, over-stressed females. In both cases, attempts to find clinical commonalities among the sufferers of each label went along more easily than attempts to establish laboratory commonalities. (At one time, chronic fatigue was thought to stem from reactivated Epstein Barr infection, until it was realized demographically that many people ostensibly with chronic fatigue did not have laboratory evidence of the reactivation and many with lab evidence of reactivation did not complain of chronic fatigue symptoms--the coorelation was just too weak.)

I suspect that Mrs. D's ideas have some merit, and that there also may be an autoimmune component to these symptoms, but I don't know if the cluster of symptoms is reducable to a term like "fibromyalgia", even though the term is being used as a "syndrome" rather than a "disease". In a similar way to how many now think about cancer, we may be looking at a cluster of distinct entities that just happen to have symptomological overlap, and that may have diverse etiologies and triggers.