ORIGINAL ARTICLE What do people search online concerning the Belusive^ fibromyalgia? Insights from a qualitative and quantitative analysis of Google Trends Nicola Luigi Bragazzi 1 & Howard Amital 2,3,4 & Mohammad Adawi 5 & Francesco Brigo 6,7 & Samaa Watad 8 & Gali Aljadeff 3 & Daniela Amital 9 & Abdulla Watad 2,3,4 Received: 24 January 2017 /Revised: 3 April 2017 /Accepted: 25 April 2017 # International League of Associations for Rheumatology (ILAR) 2017 Abstract Fibromyalgia is a chronic disease, characterized by pain, fatigue, and poor sleep quality. Patients and mainly those with chronic diseases tend to search for health-related material online. Google Trends (GT), an online tracking system of Internet hit-search volumes that recently merged with its sister project Google Insights for Search (Google Inc.), was used to explore Internet activity related to fibromyalgia. Digital inter- est in fibromyalgia and related topics searched worldwide has been reported in the last 13 years. A slight decline in this interest has been observed through the years, remaining stable in the last 5 years. Fibromyalgia web behavior exhibited a regular, cyclic pattern, even though no seasonality could be detected. Similar findings have been reported among rheuma- toid arthritis and depression. However, differently from rheumatoid arthritis and depression, the focus of the fibromyalgia-related queries was more concentrated on drug side effects and the Belusive^ nature of fibromyalgia: is it a real or imaginary condition? Does it really exist or is it all in your head? A tremendous amount of information on fibromy- algia and related topics exist online. Still many queries have been raised and repeated constantly by fibromyalgia patients in the last 13 years. Therefore, physicians should be aware of the common concerns of people or patients regarding fibromyalgia in order to give a proper answers and education. Keywords Depression . Fibromyalgia . Google Trends . Rheumatoid arthritis . Web 2.0 Introduction Fibromyalgia is a chronic condition with a prevalence among the general population in the 2–7% range [1]. It is character- ized by widespread musculoskeletal pain, heightened pain sensitivity, mood disorders including anxiety, and altered sleep patterns [2]. The pathogenesis and pathophysiology of fibromyalgia are not understood in detail yet. They should involve alterations at different levels of the components re- sponsible of the generation of pain, namely multiple ascend- ing and descending central nervous system pathways, as well as peripheral pathways of the nociceptive system, thus leading to hyperalgesia [3]. Risk factors include genetic influences, a familial predisposition, and the contributions of stress and poor, non-restorative sleep, as well as the presence of other rheumatic disorders (such as rheumatoid arthritis, osteoarthri- tis, lupus, or ankylosing spondylitis) and, putatively, diurnal physiological impairments, seasonal environmental influ- ences, and social-behavioral disturbances [4]. Recently, epi- genetic factors, such as the differential methylation of malate dehydrogenase 2, tetranectin, and heat shock protein beta-6, have also emerged [5]. Pharmacological treatments include * Abdulla Watad watad.abdulla@gmail.com; Abdvlla.watad@sheba.health.gov.il 1 School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy 2 Department of Medicine BB^, Sheba Medical Center, 52621 Tel HaShomer, Israel 3 Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel HaShomer, Israel 4 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 5 Padeh and Ziv Hospitals, Bar-Ilan Faculty of Medicine, Zefat, Israel 6 Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy 7 Division of Neurology, Franz Tappeiner Hospital, Merano, Italy 8 Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel 9 Ness Ziona-Beer Yaakov Mental Health Center, Beer Yaakov, Israel Clin Rheumatol DOI 10.1007/s10067-017-3665-y