Since the dawn of the attempt to diagnose and treat the afflictions of our fellow humans, each generation of healers has brought something new to our knowledge base and refuted something old.

We wash our hands now, and we draw blood for testing, not for draining evil humors. (Possibly we do too much of both of these.) We know that psychiatric disease and seizures are true illness and not demonic possession. Major Walter Reed controlled yellow fever not by treating the patient but by eliminating mosquitoes. It is amazing how the dogma of yesterday is occasionally replaced by wonderful new ideas.

I recall sitting in a crowded lecture hall as a medical student listening to the infectious disease specialist discuss this new illness called AIDS. This was really big stuff, and it began a new era in medicine.

Some of the newer “discoveries” I have encountered since then seem to be less important.

The significance of these new diagnoses is less clear than that of diseases such as multiple sclerosis or lupus. The criteria for diagnosis seem to be less precise than other maladies, and effective treatment is lacking. We see these patients every day and wonder how one of our colleagues has come to the conclusion that a patient has one of these new diagnoses.

Fibromyalgia, cyclic vomiting syndrome (CVS), and neurocardiogenic syncope (NCGS) are three relatively new diagnoses that when made indiscriminately have questionable veracity.

Before someone from the Cyclic Vomiting Syndrome Association gets their dander up, I’ll say that I’m sure there are plenty of bona fide patients who have these illnesses. It seems, however, that these diagnoses get tossed around like we tell people they might have a viral illness or constipation. It is the uncritical use of these diagnoses that harms those that truly have the illness.

Are we doing anyone a favor by labeling them with a term that suggests they have a problem not related to its root cause?

Traditionally CVS has been a diagnosis made in children. Lately I’m seeing adults newly diagnosed with this. Could this be a real entity? Sure, but I’m suspicious when many of these patients are heavy users of either oral opiates or marijuana. Possibly the nuclear explosion of opiate use in the United States has something to do with this.

Also, since the illness in adults seems to be rooted in panic disorder, maybe a better term for what these patients have would be anxiety-related vomiting. Calling an illness by a more specific name may help to direct therapy to the root cause.

NCGS covers a wide range of syncope disorders. Many patients have high vagal tone and faint easily. There are multiple triggers for this, including pain and changes in posture. Other “triggers” are various neuroses. It seems that quite a few neurotic patients carry this diagnosis now.

To avoid lumping these patients with those who have a significant physiologic cause, possibly another name would be more useful. Syncope neuroticus comes to mind. Choosing a proper name would help to direct therapy toward treatment of the anxiety rather than its symptom.

I’m sure there are patients with fibromyalgia who do not have accompanying psychiatric disease. I don’t see them in my practice, but they must be out there. It seems that fibromyalgia is mainly a physical manifestation of depression. I don’t doubt that these patients are uncomfortable. I do doubt the need for a term that does not acknowledge this relationship.

That there are different types of pain is well known. Ketorolac is great for renal colic but terrible for a fractured femur. Opiates are great for a fractured femur but only marginally effective for herpetic neuralgia. Gabapentin works well for herpetic neuralgia but not renal colic.

If the root of fibromyalgia is related to depression, it makes sense to treat it with an SSRI and leave the opiates for ailments and conditions such as crush injuries.

Are we doing anyone a favor by labeling them with a term that suggests they have a problem not related to its root cause?

I think not.

Physical manifestations of psychiatric illness are well known, so why hide behind vague terminology? Just tell the patient that multiple tests are normal and that you believe the symptoms are related to depression, anxiety, or addiction.

Now let’s treat that.

These diagnoses have their proponents who make sound arguments regarding these conditions. Unfortunately, these diagnoses have become the wastebasket for a population of patients who are mostly anxious, opiate addicted, or depressed.

This puts us in a conundrum in the emergency department. These diagnoses are not easily proved or disproved. Once a patient has been labeled with one of these, there is no politically correct or Press Ganey–friendly method of changing that.

I don’t have this discussion with patients because it is a swim upstream in a cold and rapid river. Instead, I’m content to watch the river flow and use my prescriptive authority sparingly.

Be happy.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.