I agree totally. The cause of fibromyalgia is life's challenges and the person's resources to recognize, respond appropriately and address the issues constructively. I have never seen a fibromyalgia patient who was "living happily ever after". Nevertheless, as rheumatologists were are committed to helping our medical colleagues who do not like the clinical uncertainty and the patients who have a terrible quality of life. We can protect the patients from iatrogenesis and provide a meaningful explanation so they can go about seeking assistance with their life's circumstances. A little cognitive therapy goes a long way. Caveat: some patients are so disappointed or concrete (defense mechanisms, mood disturbances, abuse issues, personalty disorder, intellectual deficits) they may try to "kill the messenger" when they don't like the message. No doubt many patients with entrenched illness and pain behavior with associated "drama" require a lot of time and can drain the resources of the entire staff. Also, fibromyalgia can confound and hinder the determination of co-existing medical pathology. We have to help the patient help themselves with support, reassurance and information. Not easy!