The pain struck Frances Bremer while she made lunch.
Two sandwiches, two apples, and cookies went into ordinary brown paper bags for her children. Suddenly, Bremer became aware that the small, jagged edges at the opening of each bag were so painful to the touch that she could not finish preparing the lunches.
"I couldn't put my hands in the bag or fold it up," Bremer said.
Bremer, the 65-year-old wife of former United States ambassador to Iraq Paul Bremer, was feeling the first pangs of what doctors now call fibromyalgia. It is a condition characterized by chronic migratory pain and sensitivity, often accompanied by chronic fatigue syndrome, irritable bowel syndrome, and poor sleep.
No one knows the cause of fibromyalgia, and some now question whether the combination of symptoms adds up to a disease. The debate has intensified since last year, when drug giant Pfizer launched a campaign to promote Lyrica, the first drug approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia.
Critics say there is no reason to classify fibromyalgia as a disease.
"There is no such thing as a fibromyalgia person," said Dr. Nortin Hadler, professor of medicine at the University of North Carolina's school of medicine in Chapel Hill. "The issue is not is it real... the issue is, are they diseased so that we need to fix their biochemistry or their minds. It's fairly counterintuitive."
Fibromyalgia can be difficult to diagnose -- which becomes a problem when patients feel their pain is not being taken seriously.
"These people get a bad rap," said Dr. Doris Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine's department of anesthesiology. "Doctors think this person is goofy because the pain kind of moves around."
Dr. Cheryl Bernstein, assistant professor of anesthesiology at the University of Pittsburgh, said a doctor's skepticism may stem from their lack of exposure to patients with fibromyalgia. Though individual instances of pain may sound commonplace, "the emotions expressed are very similar and the stories tend to be very consistent," she said. "It is hard to ignore it once you see it over and over again."
Still, it may not be surprising that some doctors are slow to recognize the symptoms of the condition. Fibromyalgia has only been part of the medical lexicon for about 15 years. Its causes are murky and have been linked to physical or emotional trauma, such as a car accident.
About 3.7 million people in the U.S. have fibromyalgia, according to the Centers for Disease Control and Prevention (CDC). Middle-aged women are particularly susceptible, but pain can strike at almost any age, with some reported cases occurring in patients as young as 8.
Bremer said she began to experience chronic pain in her 30s.
"My clothes began to hurt," Bremer said. "I would lie in bed and then change from one nightgown to another ... It was like my blood was on fire."
Prolonged exposure to pain alters how the brain processes pain signals from the body, causing it to become sensitive to the lightest touch. This is one of the reasons that over-the-counter pain relievers like aspirin and ibuprofen do not have much effect on patients with fibromyalgia.