Correspondence (letter to the editor): Complex and Heterogeneous

Recommendations are an extraordinarily labor intensive achievement, especially as—in tune with the trend of the times—evidence based, rather than rationally guided, studies were favored. When studying the deluge of information it is easy to lose sight of the wood for the trees.

According to the pioneering studies by Wolfgang Müller and colleagues, the “generalized tendomyopathy” (a synonym for fibromyalgia; the term was coined by Müller in 1976) is diverse in its pathogenesis (mostly from primary monolocular pain syndromes) and its course (1). My personal observations of about 1000 patients certainly support this knowledgeable statement; the complexity with impairments and complications seems to increase during the course of the disease. These facts restrict the value of general, so called nomothetical, statements and require the particular observation of individual, sometimes unique, idiosyncrasies. Taking a thorough medical history and biography is the ideal way to approach subjective experiences.

Klaus Mainzer’s request for “thinking in complexity” (2), which has already been introduced into many other disciplines outside medicine, is, in this context, more instructive for explaining and understanding the condition than any attempts to identify the “cause and effect relation,” especially because different physiological changes and psychopathological findings have been confirmed. I think that, all that has been detected relates to merely probable relations following a circular causality principle, and not linear, determined correlations between stimulus and reaction (3).

A simple, further pointer for treatment: affected patients almost always describe the influence of heat as positive and that of cold temperatures and moisture as negative. This does not necessarily mean a “spa treatment” but a hot shower or bath; not prescribed Fango packs but using hot packs from the microwave. Heat is evidently more beneficial than the significantly—but rarely convincingly effective—amitrityline with its associated weight gain.