{
  "abstract": "Fibromyalgia (FM) is a diagnostic construct defined by clinical criteria, lacking biomarkers\n\nand a gold standard of reference. A non-negligible proportion of patients diagnosed with FM\n\nactually present, either instead or in addition, other often uninvestigated conditions, most notably\n\nsmall fiber neuropathy (SFN). This article does not propose a new etiopathogenetic theory;\n\nrather, it makes explicit three logical and clinical paradoxes that run through the diagnosis and\n\nmanagement of FM. First paradox: positive criteria exist, but an external validator is missing. The\n\nliterature documents overdiagnosis and misdiagnosis, and successive revisions of the criteria have\n\nredistributed the error rather than eliminating it; nonetheless, the diagnosis is often treated as\n\ndefinitive and may close the door to alternative investigations. Second paradox: FM is frequently\n\npresented to patients as incurable, yet follow-up studies and clinical testimonies report that a\n\nvariable proportion of patients improve or no longer meet the diagnostic criteria. These data are\n\nheterogeneous and do not equate to a cure, but they do not justify a uniformly negative prognosis\n\nand deserve to be studied rather than dismissed. Third paradox: in the absence of biological\n\nmarkers, the diagnosis relies on symptomatic criteria involving cognitive, affective, and somatic\n\ndimensions, and the ICD-11 definition is explicitly biopsychosocial; yet psychological assessment\n\nis not considered a structural part of the diagnostic pathway. It is argued that the three paradoxes\n\nare interconnected and that making them explicit has potential clinical, methodological, and\n\neconomic consequences. A summary table lists the main conditions that mimic FM and should\n\nbe included in the differential diagnosis. A second paper will address the interoceptive-emotional\n\nintegration model and its therapeutic implications.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "name": "Alessandro Mahony",
      "orcid": "0009-0009-4876-3510"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/37chpwgrdn2p1.bib",
  "cited_by": 0,
  "doi": "10.5281/zenodo.23649789",
  "fulltext_url": null,
  "id": "37chpwgrdn2p1",
  "issns": [],
  "landing_url": "https://zenodo.org/records/23649789",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2738|Fibromyalgia and Chronic Fatigue Syndrome Research"
    ]
  ],
  "openalex": "W7223561939",
  "pdf_url": "https://zenodo.org/api/records/23649789/files/Fibromyalgia.%20Three%20Paradoxes%20of%20Diagnosis.pdf/content",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-25",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/37chpwgrdn2p1.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T12:20:59Z",
      "native_id": "23649789",
      "source": "zenodo",
      "url": "https://zenodo.org/records/23649789"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2738|Fibromyalgia and Chronic Fatigue Syndrome Research",
      "subfield": "psychiatry"
    }
  ],
  "title": "Fibromyalgia: Three Paradoxes of Diagnosis",
  "title_text": "Fibromyalgia: Three Paradoxes of Diagnosis",
  "type": "preprint",
  "updated_at": "2026-11-08T12:20:59Z",
  "url": "https://research.draconitic.com/paper/37chpwgrdn2p1",
  "venue": "Zenodo",
  "versions": []
}